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7I CITY OF Evergreen <br />CO J CT I Q N <br />everett <br />PERMIT <br />CITY HALL 259.8745 <br />PERMIT NO.Orj3$3 <br />EVERETT, WA 98201 <br />❑ COMBINATION <br />❑ BUILDING U MECHANICAL <br />❑ PLUMBING <br />OWNER <br />Paullette <br />Ginnard <br />MAIL ADDRESS CITY <br />117 Sydney Lane Everett <br />TIP PHONE <br />98203 353-2921 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CRY <br />ZIP PHONE <br />Everett Builders 5606 Ever seen Wa CITY ZIP PHONE CENSEE <br />B Y 98203 353-7161 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />EV ER EB 301PH <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />❑NEW EIADDITION ❑ALTERATION I.RREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />S 4134.00 <br />re -side <br />PROPOSED USE OF BUILDING <br />single family residence <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 />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT LOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO. <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN UP `CONTRACTOR OR IZED AGENT DATE <br />/19/79 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />27 WESTWCOD <br />LOT RLOCK.—OF <br />JOB ADDRESS <br />116 Sydney Lane <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 />A q COND. UNITS — H P. EA <br />BATHTUB <br />12FRIGERATION UNITS — H.P. EA <br />A UN <br />LAVATORY (WASH BASIN) <br />)OILERS H.P. <br />SHOWER <br />GAS FIRED A . UNITS — TONNAGE EA. <br />KITCHEN SINK 8 DIST <br />I FORCED AIR SYSTEMS — B.T.U. <br />DISHWASHER <br />WALL HEATERS —B.T.U._ M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />_ <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 <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL S <br />SUB TOTAL <br />PERMIT S <br />PERMIT S <br />TOTAL FEE f <br />1 <br />1 <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />N0. OF DWELLING UNITS <br />BUILDING <br />5 4134.00 <br />32 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ❑NU <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />32 <br />00 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />Coq � <br />A CC) <br />T � <br />5, GRADING <br />6, DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />6. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />__ ADDRESS FILF 1 9 1% 79 <br />