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Mc Eivrgreen <br />CONSTRUCTION <br />CITY GE <br />everett <br />PERMIT PERMIT N0. 09079 <br />CITY HALL 9El COMBINATION <br />ki BUILDING ❑ MECHANICAL El PLUMBING <br />EVERETT. WAA98201 8201 <br />MAIL ADDRESS CITY 21P PHONE <br />98204 355-1190 <br />OWNER <br />Jerald A. Bentz 9320 <br />Sharon Drive <br />ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL PDDPESE CITY <br />CITY 21P PHONE UCENSE L <br />GENERAL CONTRACTOR <br />MAIL AC`DRESS <br />Same <br />dTY 21P ONE UCENSEA <br />MECHANICA'_ CONTRACTOR <br />MAIL ADDRESS <br />CITY Zip PHONE LICENSE � <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CLASS OF WORN <br />EINgy ❑ADDITION <br />❑ALTERATION 99�EPAIR ❑DEMOLITION ❑FENCE []SIGN EIGARAGE <br />VALUATION OF WORK <br />_ <br />500.00 <br />S <br />_ _— <br />DESCRIBE WORK <br />Repair foundation and patch sheet rock <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THISAP- <br />Retail Sales <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />----- <br />v GAL DESCRIPTION OF PRY (SHOW BELOW OR ATTACH FJUR COPIES) ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />WILL BE COMPLIED WITH WHETHER SPECIFIED <br />_oT 6-7 BLOCK-5 of Friday' <br />s St TYPE OF WORK <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />ANY OTHER STATE OR LOCAL LAW REGULATING <br />VISIONS F <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN�UjiE OF CONTRACTOR OP AUTHORIZED AGENT DATE4 / 6 / 81 <br />JOB ADDRESS <br />. <br />3511 Rucker Avenue <br />/ <br />L MECHANICAL <br />PLUMBING <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />AIR COND. UNITS - H.P. EA. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS - H.P. EA <br />BATHTUB <br />BOILERS - H.P. GA. - <br />LAVATORY (WASH BASIM <br />GAS FIRED A.C. UNIT -TONNAGE FA. <br />SHOWER <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />KITCHEN SINK &DISP. <br />WALL HEATERS -AT.11 M <br />DISHWASHER <br />-ill urATORR -RT.U. M <br />- PAR. ETC.1 <br />SUB TOTAL <br />-- PER�FEE <br />-- TOTSIDE YARD SETBACK STREE <br />BLDG. I NO. <br />REAR YARD SETBACK ILI' <br />FEE I RECEIPT NO. <br />VACANT SITE FEES I VALUATION FEE <br />OYES ONO <br />NO. OF DWELLING UNITS' <br />.n11RniMr. 5 500.00 10 00 <br />I BASEMENT <br />REQUIRED - <br />MECHANICAL <br />1 <br />OYES ONO <br />BY DATE <br />OTHER <br />APPROVALS <br />ONMEN'AL CHECK LIST <br />PENALTY <br />DING PEWS <br />TOTAL <br />tF1E <br />HYDRANT <br />pERMiT YALPROTECTION <br />SI STEM <br />WHEN PROP(INGINAGEIR0 <br />4MENTAL IMPACT STATEMENT <br />LT I DISTRICT <br />APPLICA ION ACC. BY PLANS CHECKED BY <br />APPR. FOP. ISSUANCE BY <br />DAB <br />ADDRESS FILE <br />U.B.C. <br />SEC. 303 (A) <br />10 00 <br />iTION <br />Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />$010.00-°L <br />62r5CD <br />� <br />pI� <br />1 •. 4P, �.. <br />1,h <br />