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(heErerg�een � CO�ISTRUCTION - � � <br />CITY 0� <br />everett PERIUIIT pEFiMIT NO. 0�596 <br />CiTY HALL'159�8745 <br />e:-eaen, �va oszo� ❑ COM61NA710N ❑ 9UILD!NG C� ME�HAfIICAL ❑ PLUMBING <br />OWM1EN NAILADDRLSS LI1Y ZIP PMONE <br />Victor Bolstad 8611 Xavier Way 98204 353-7204 <br />PfiCHIiCCi OP UESIG4ER MAIL ADOflE55 CITY 21P PHONE <br />GCNERRICONTRACiOR MAiLADDPE55 CIiY ZIP PHONE UGENSE� <br />Self <br />MECMANIGL CONiPACTOR MAII ADDRC55 piY 21P PHONE IICENSE 1 <br />PLIIMBIFGCONTpnCiOR MAILADDRE55 CITV ZIP PHONE UGENSE♦ <br />❑NEW C�ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />\'ALUATIOf: JF WORK <br />S 1�00�.�0 <br />DE:.CRI�E WORK � <br />30x10 Deck & Cover . <br />LEGAL DESC?iPT10N OF PROPE <br />ior 18 s�oc�_ <br />Division No. 2 <br />JOB AODiiE55 <br />8611 Xavier W <br />PLUMBINO <br />SIZE OF <br />I HEREBY CERT'FY THAT I HAVE READ A�ID EXAMINED THIS AP- <br />is�owaeiowonnrrncHFouncowea PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />Beverly View Lands ALL PROVISIONS OF LAWS AND ORDINANCFS GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE uRANTING OF A PERMIT DOES NOT <br />PRESUME TO GI�E AUTHORITY TO VIOLATE OR CANCEL THE PRO• <br />VISIONS OF ANY �::THER STATE OR LOCAL LAW FEGULATING <br />CONSTRUCTION OFi THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAiUR[ OF CONiRACTOR OP AUiMORIZE� FGENT UAIE <br />Everett X 5-16-80 <br />MECHANICAL <br />TYPE OF FI%TURE <br />KITCHEN SINK 6 DISP. <br />FOOF DRAINS — RA W LEADERS <br />SINK 1SERVICE — �AR ETC 1 <br />ZOMF. <br />SETBACN I STREET SETBACK <br />LOT AREA <br />STORIES <br />1. ENVIRONMENTALCHECKLIST <br />2. BUILOING PLANS <br />3. FIRE HVDRANT <br />4. FIRE PRUTECTION SVSTEM <br />5. GRADING <br />6. DflAINAGE <br />7. ENVIFONMENTALIMPACTSTATEMENT <br />B. HEALTH DISTRIGT <br />APPLICATION ACC. BV PU+Nu CHECNEO BY <br />REAR VARD SETOACK <br />VACANT SIiE <br />❑YES L'NO <br />NO.OF DWELLING UI <br />MA%.00C.LOAO <br />— H.P. EA <br />— H P. EA <br />ano i v�cv n.�. vrvno — <br />FORCEO AIR SVSTEMS — <br />WALL HEATERS — B.T.U. <br />UNIT HEAT[RS — B T.U. <br />EVAPORATIVE COOLE�S <br />AIPNAkDLINGUW� ._ C.F.bI. <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />?LAN ( <br />fEE <br />VAIUATION <br />S1r���.00 <br />U.B.C. <br />SEC.303(a) <br />i <br />RECEIPT NO. <br />� �� <br />WHEN PROPERLY VALIDATED (IN TNIS SVACE) TNIS IS Yp PE MI � <br />2141 7� � i�. 0 �� ,: <br />� <br />� <br />YOUR RECEIPiti <br />APPN. FOR iSSUANCE BY I I I�P�:� YO U O <br />ADDRES$ i ILE <br />I b �ar 8 D <br />