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rhe !: reremerr <br />everett I� �� N ST R U CTI O IV� � <br />CITY HALL'.59-07d5 P E R M IT PERMIT NO. �` <br />eveaerr,waesso� � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />CWNER MAiLAODRE55 CiiY ZIP PNONE <br />Lverett Clinic 3912 ColUy Ave. Cverett 98201 259 096 <br />rtRCN1iEGi OR OES GNCP MAtL ADDRE55 CIiY ZIP PMONE <br />G11erUe 6uilders, Inc. P.O. Box 1891 Everett 98206 259-6563 <br />GENERAI GONTRnQOR MAIL AODRE55 GTY ZIP PMOkE LICENSE � <br />MEGHANICAL WNTRAGtOR MAIL pDORE55 GITY Zlp PMONE LICENSE 1 <br />^WMBING CONiqq�TOP MAIL ADORE55 CITY ZIP PMONE LICENSE � <br />❑ NEW ❑ ADOITION ❑ A�TERATION ❑ qEPFIR XX DEMOLITION ❑ FENCE ❑ SIGN ❑ WOO� STOVFJFIREPLACE INSERT <br />WORN <br />5 <br />�ESGFIBE WORN <br />���• �� g Structure <br />PROPOSE US�E� F I � � <br />LEGAL OESGPIPiION OF PqOPSPTY �SNOW BELOW OR ATT� <br />LOT__BLOLK_OF <br />Lot 11 F, 12, Block S of flimax <br />Addn to Gverett 61k 005 D-00 <br />JOB ADDPE55 <br />3921 Rucker <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET�iOILEn <br />OATHTU6 <br />SHOYJEfl <br />NITCMEN SINK 8 DISP. <br />DISHWASMER <br />LAUNDRVTflAY <br />CLOTHES WASNER <br />WATER HEATER <br />URINAI <br />DRINi ING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF ORAINS — RAINLEADERS <br />SINK �SERVICE — BAR, ETQ) <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />SIDE VARD SEiBACK STREET SETBAi <br />USE ZONE LOT AREA <br />TYPE OF CONST. OCCUPANCY GI <br />SIZE OF BLOG. NO. OF STORIE'� <br />FIRE ZONE BASEMENT <br />APPROVALS <br />1. ENVIRONMENTAL CMECK LIST <br />2. BUILOING PLANS <br />3. FIRE HVDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATENENT <br />8. HEALTH DISTRIC7 <br />S <br />S <br />5 <br />YES : NO <br />NO. OF DWEL <br />YES NO <br />3� <br />BY IAPPR.FORISSUANCE BY <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH�S <br />APPLICATION AND KNOW THE SAME TC �E TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND Ok�INANCES <br />GOVERNING THIS TYPE OF WORK WIL� BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRU'CTIOIJ OR THE <br />PERFORMANCE OF CONSTRUCTIQ";. <br />SIGN 1TUPE OL!� CONiR TOR OR UtHOFIZEO OG[NT pqTE <br />X 1, c�f � .�-Ei �_� % 1L..1 � Fi � <br />TYPE OF EQUIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIG[RATION 11NITS — M.P. EA. <br />BOILERS — M.P. EA. <br />GAS FIRED A.C. UNIiS — TONNAGE EA. <br />FORCED AIR SVSTEMS — O.T.U. M EA. <br />WALL MEATEflS — B.i.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLO"'HES DRYERS <br />VENTI�qTION FAN <br />RANGEMOO� <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE & CMIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTV <br />SUB TOTAL f <br />PERMIT 5 <br />TOTALFEE S <br />PLAN CHECK PEE <br />FEE RECEIPT NO. <br />VALUATION FEE <br />E <br />U.B.C. <br />SEC. 309 (a� <br />TOTAL I I <br />PEpM1T VALIDATION <br />WHEN PROPERLY VALIOATED (IN THIS SPACE� THIS IS YOUR PE(iM1T <br />AUDRESS FILF <br />