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1he !i rer; reen <br />everett CONSTRUCTIOr� <br />PER�IT PERMIT NO. 1�'�`�� <br />CITY HALL 259�8745 <br />Evenerr.wn9ezoi � COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNEfl MAIL ApORE55 GTY ZIP PNONE <br />1VILLARD DEA1ARAIS 18s1 SUAI�1IT AVH �VERGTT l4A 98201 252-8483 <br />ARGMREGT OR DEStGNEP IdqtL qODRE55 QTY 21P PHONE <br />GENERRLWNTRAGTOR IdA1LA0DRE55 CITY ZIP PHONE LICENSE� <br />Owner <br />MEGMANICAL CONiRACTON MAIL ADDRE55 CITV ZIP PMONE LICENSt � <br />PLUMBING CONTRAGTOH MAIL AD�RE55 QTY ZIP PHONE LiCENSE M <br />�NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN O WOOD STOVFJFIREPLACE INSERT <br />�ALUATpION OF WORK <br />S OQ��.O� <br />IESCRiBE \YORK <br />Construct garage <br />'POPOSED USE OF GUILOING <br />Garage <br />[GAl DESCRIPiION OF PPOPERiY �SMOW <br />�or 1_Z oiocK �,7oF ��N <br />PLUM8ING <br />,.l:l <br />SHOWER <br />KITCHEN SINK S DISP. <br />OISHWASHER <br />LAUNDRYTRAY <br />CLOTMES WASFER <br />\NATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />ROOF DRAINS — RAINLEADERS <br />SINK �SERVICE — OAR, ETC.) <br />SIDL YAP <br />� <br />USE ZONI <br />R- <br />TYPE OF <br />v' <br />SIZE OF [ <br />83 <br />FiR� zoN <br />1 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 �NILL 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 C CEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOC/(� LAW REGULAyiNG CONSTRUCTION OR THE <br />PEI�ORMANCE OF COIQSTRUCTION. <br />AGENT OlTE <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — 6.T.U. M EA. <br />WALL MEATEPS — B.T.U. M <br />UNIT MEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />SUB TOTAL S <br />PERMIT f <br />'(OTALFEE S <br />EETSETGACK REAR VARD SETBACK <br />�' <br />AREA VACANT SITE <br />YES NO <br />:UPANCY GROUP NO. OF DWELLING UNITS <br />OF STOPIES MAX. OCQ IOAD <br />APPROVALS <br />1. ENVIRONMENTAL CHECN LIST <br />2. BUILOING PLAN$ <br />3, FIRE MYDRANT <br />a. FIRE PROTECTION SYSTEM <br />5. GRADING <br />fi. ORAINAGE <br />7.ENVIRONMENTALIMPACTSTAT <br />B.HEALTH DISTflICT <br />STG I H15fi1 <br />� <br />ECKED BY IAPPR.FORISSUANCE BV <br />LNC <br />83/12249 <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />SUB TOTAL <br />PEflMIT <br />TOTALFEE <br />FEEZ 5 . � 3 <br />VALUAl10N <br />FEE <br />� <br />5 <br />S <br />�HECKFEE <br />FECEIPT NO. <br />6� 6 5� <br />FEE <br />� <br />�7�5 �- <br />• <br />TOTAL I I Os I5� <br />PERMIT VALIOpTION <br />WHEN PROPERLY VALIDATED pN THISI55AGCE� THIS ��(O�IFif�1.+�T ��Q� <br />�O � � � <br />19.50 due on plan check fee N <br />{� p�{r�i <br />���; U li �ECC�1 I'. : <br />''^,'�"K YOU <br />�.��� . ���. . <br />I 2 �P 8 3 <br />z <br />0 <br />-i <br />c� <br />m <br />� T <br />rv-� �--� <br />Vt 2 <br />0 <br />m <br />c o <br />m o <br />-i c <br />O 3 <br />m <br />-i z <br />2 -i <br />m <br />.O Z <br />C <br />D � <br />rx <br />�� <br />-G <br />O A <br />�, n <br />-i m <br />2 <br />fTl N <br />0 <br />o r <br />nm <br />C N <br />� � <br />m <br />Z ('� <br />-� r <br />• m <br />n <br />z <br />-� <br />s <br />n <br />z <br />--1 <br />.=-i <br />N <br />2 <br />O <br />.�-� <br />(� <br />m <br />