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the Evergreeen - �;ONSTRUCTIW` <br />ll�everett PERMIT <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ BUILDING ❑ ML CHANICAL <br />PERMIT NO. 15251 <br />YX PLUM31NG <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Gene Closser 4212 Rucker Everett 98203 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 4 <br />Star Home Improvement 5314 2nd Street Everett 98201 353-92n <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IN <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 0 <br />Walts Plumbing 3224 109th Street Everett 98204 3�3T88-11g4815 <br />CUSS OF WORK ❑ NEW O ADDITION ❑ ALTERATION O REPAIR ❑ CFMOLITION ❑ FENCE ❑ SIGN O PWOOD TRVVE AEP5ggp <br />LACE INSERT <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL 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 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR R AUTHORIZED AGENT DATE <br />X 8 2 85 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELCW OR ATTACH FOUR COPIES) <br />LOT_BLOCK_OF <br />JOB ADDRESS <br />4212 Rucker <br />PLUMBING <br />MEC'IANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />2 <br />rin <br />AIR GONG. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />j <br />LAVATORY(WASH BASIN) <br />2 <br />0 <br />BOILERS — H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA, <br />KITCHEN SINK f DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA, <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — 8.T.U. M <br />j <br />CLOTHES WASHER <br />2 <br />00 <br />EVAPORATIVE COOLERS <br />j <br />WATER HEATER <br />2 <br />00 <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE — WOOD <br />ROOF DRAINS — RAINI_EADERS <br />METAL FIREPLACE d CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />1PlImp <br />2 <br />00 <br />HEAT PUMP <br />SUB TOTAL <br />111 <br />10 <br />00 <br />SUB TOTAL f <br />PERMIT <br />S <br />PERMIT f <br />TOTAL FEE <br />$1 <br />13 <br />00 <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />..YES NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />E <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />13 <br />00 <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REOUIRED <br />YES NO <br />MECHANICAL <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />13 <br />OO <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT �! <br />Liz <br />Ln <br />LN <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CM ECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />