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the Evergreen <br />;O N ST R U CT I O N' <br />CITY OF <br />everett <br />PERMIT <br />PERMIT NO.09898 <br />Cm H,%L :.,.I _ : : <br />COMBINATION BUILDING MECHANICAL <br />PLUMBING <br />EVE=LI :. <br />OW,L, <br />MAIL ADDRESS 617Y <br />Ronald L. <br />Iiansen 8514 East Xavier Play Everett 98204 353-7515 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE) <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSEE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />❑NEW <br />❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE <br />❑SIGN ❑GARAGE <br />S <br />install wood burning stove <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH FOUR COPIES) <br />LOT —BLOCK. —OF _ <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE On CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF NTRhOTOR OR AUTHORIZED AC i DATE <br />a 10/12/81 <br />JOB ADDRESS <br />8514 East Xavier Wav <br />X <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — HP. [A. <br />BATHTUB <br />REFRIGERATION UNITS — M.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS —BT.U. M <br />I INIT WIPATFRS — R i 11 M <br />SIDE YARD SETBACK <br />USE ZONE <br />TYPE OF CONST. <br />SIZE OF BLDG. <br />STREET SETBACK REAR YARD SETBACK <br />LOT AREA VACANT SITE <br />DYES FIND <br />OCCUPANCY GROUP NO, OF DWELLING UNITS <br />OF <br />I. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STAI EVENT <br />B. HEALTH DISTRICT <br />APPLICATION AOC. BY I PLANS CHECKED BY <br />114m <br />BY <br />APPR. FOR ISSUANCE BY <br />AIR HANDLING UNIT — <br />TOTAL FEE 6 <br />PLAN CI IECK NUMBER PLAN CHECK FEE <br />FEE I RECEIPT NO. <br />S <br />17150 <br />PENALTY I SEC 303 (a) <br />TOTAL 17 I 5 C <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />l i <br />ADDPESS F11 E r <br />