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dteErer,�reen C7NSThUCTION � � <br /> �iTY�F <br /> everett PER��IT PERMIT NO. 09531 <br /> GTV HALL 259�87a5 <br /> [VEREiT.l4A 98201 ❑ COMBINATION ❑ BUILDING X;EX� MECHANICAL ❑ PLUMBING <br /> OIYN[H I,IAILHUDRE55 C�iY ZIP fHONL <br /> REGINALD ANDERS0t4 8520 E Xavier 1�lay Everett 98204 353-6223 <br /> AfiP�liCCiOPDE5IGNER MAqqDDRE55 fliY ZIP p��pq[ <br /> GCNERALCONiRACTOq MRILA�DRE55 CrtY ZIP PHONL LIC[NSE� <br /> Owner <br /> M[GMANICALCqNTFRCTOH MAILADDRE55 CIiY ZIP FHONE LILENSEI <br /> PWN�INGCONTNACiJR MnILpDDR[55 CItY 21P PHG..E IICENSE� <br /> CLRSSOF WpRK <br /> XXIJEW ❑AD':ATDN ❑ALTERAlION ❑REPAIR ❑DEMOUT�ON ❑FENCE CSIGN ❑GARAGE <br /> VALUATION OF WOPK <br /> S <br /> �EFiCHIBE WORK <br /> Install air-tight stove <br /> raoaoseo usE oF eui�oiNc <br /> Residence I HEREBY CERTIFY THAT I HAVE RE:�D AND EXAMINED THIS AP• <br /> iecnt oescaianoN oF vnovearr�sNow oe�ow oR nrtacN Foua coeiesl PUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> ior o�ocrc__oF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HEREIN OR NOT. THF GRANTING OF A PERMIT DUES NOT <br /> , PRESUN,E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO� <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> C UCTION OR THE PFRFORMANCE OF CO"STRUCTION. <br /> JO�ADORE55 SIGN RE OF CONiRACLO UTH IZED AGEN1 UO1E <br /> 8520 E. Xavier Way X � �/22/8� <br /> PLUMBING MECH NICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> _ WATER CLOSET(TOILET� Flq CCND.UNITS—H.R EA <br /> BATNTU� REFRI6ERATION UNITS—H.P.EA <br /> LAVATORV(YlASH�ASIN) BOILERS—H P EA. <br /> SHOWER GAS FIRED AC.UNI75—TONNAGE EA. <br /> KITCHEN$INK 8 DISP. FORCED AIR SVGTEMS—F3.T.0 M EA. <br /> DISHWASHER WAILHEAi[RS—D.T.U. M <br /> LAUN[1RV TRAV UNIT H[ATERS—D T.U. M <br /> CIOTNES WASHEN EVAF'ORATI\'ECOOLERS <br /> \YATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DflINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— CF.M. <br /> VACUUM BREAKERS STOVe <br /> ROOF DRAIN$—RAINLEADERS N.ETAL FlREPLACE 8 CHIMNEY <br /> SINK(SERVICE—BAR,ETCJ <br /> SUB 70TAL SUB TOTAL S <br /> PERMIT S PERMIT f <br /> TOTAL FEE S TOTAI.FEE S <br /> SIDE VARD SETBACK STREET SETDACK REAR YARD SETOACK PIAN CHECK NUMBER PU+N CHECK FEE <br /> fEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> L]YES ❑NO FEES VALUATION FEE <br /> TVPE OF CANST. OCCUPANCY GBOUP NO.OF OWCLLING UNITS <br /> SIZE OF BLOG NO.OF STORIES MA%.00C.LOAD DUIL�ING 5 <br /> PLUMBING <br /> FIREZONE BASEMENT FIRESPRIIJKLERS <br /> REOUIRED MECHANICAL �4 5O <br /> ❑YES ❑NO <br /> APPNOVALS BY UATE O7HER <br /> 1. ENVIRONMENTALCHECKl15T PENALTV U.BC. <br /> 2. BUILDINGPLANS SEC.303�a) <br /> 3. FIRE HYDRANT TOTAL �Q 5� <br /> 4. FIRE PROTECTION SYSTEM PERMIT VALIDqTION <br /> — WHEN PROPERLV VALIDATED(IN THIS SPACE)THIS IS YOUR PERMIT <br /> 5. GRADING <br /> 6. DFAINAGE <br /> � <br /> Z ENVIRONMENTAL IMPACT STATEMENT ( I r) " I ," r r — � <br /> 8. HEALTH DISTRICT � <br /> APPLICATION ACC.0Y PLANS CHECKED BY APPR.POR ISSUANCE BY � � � <br /> ADDRE55 FIL[ <br />