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�he Evergnen <br />CITY OF <br />everett <br />CITY HALL 259E7�5 <br />EVEFETT, WA 982C7 <br />� �ONSTRUCTIOI� � <br />PERMIT PERMIT NO. 16353 <br />G(I COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBINO <br />OWM MAIL ADDRE55 CITY 21P PMC'NE <br />LESSLEY CONSTRUCTION 18204 Bothell Everett Hwy B2 Bothell WA 96012 481-8866 <br />ARCHITECT OR DESIGNER MAI� AOORE55 CITV ZIP PHpNE <br />GENERAL CONTRACTOp M�IL pDDflE55 CITV ZIP PHONE LICENSE 11 <br />Same <br />MECHANICAL CONTflRCTOP MAIL ADDflESS QTY ZIP PMONE UCENSE I <br />PLUIdBING CONTRACTOR MAIL AODRE55 � CRY ZIP PHONE LICENSE I <br />CU55 O� WORK <br />I� NEW ❑ ADDITION ❑ ALTERATION ❑ FErAIH ❑ DEMOLITION ❑ FENCE O SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />f rJ���O�.�� <br />DESCPIBE WORK <br />New single family residence <br />Single family residence <br />�or 33 BLOCK_..OF <br />IYVJ � <br />PLUAIBINO <br />NO. I TYPE OF FIXTURE OR ITEM <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />UR:NAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL f <br />PEHMI7 S <br />TOTAI- FEE S <br />iETBACK TREET SETBACK RE <br />6� J 2�� <br />R-1 <br />V-N <br />SIZE OF BLDG. <br />1415+308 <br />R-3 <br />�Z <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />8. DRAINAGE <br />7.ENVIHONMENTALIMPACTSTATEME <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS C <br />sg <br />FEE <br />I 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 WILL BE COMPLIED WITN <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT, DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR � ANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOR CE OF CONST N. <br />SIGNATUflE CONTRACTOR OF AUT IZ AGENT DATE <br />X _ /�/�t ,//yit'li/i <br />N0. TYPE OF E�UIPMENT <br />AIR COND. UMITS — H.P. EA. <br />REFRIGERATION UNIT: — H.P. EA. <br />BOILERS — H.P. EA. ��� <br />GAS FIRED A.C. UNITS — 70NNA E E <br />FORCED AIR SYSTEMS — <br />WALL HEATERS — B.7.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />� CLRiHES DRYEflS <br />� VENTILATION FAN <br />j RANGEHOOD <br />AIR HANDLING UNIT — � <br />STOVE — WOOD <br />� METAL FIREPLACE 8 CHIM <br />FIREPLACEINSERT <br />HEAT PUMP <br />20' � 86/16365 <br />xYEs �.�o <br />NO. OF DWELLING l:':.'�� tate <br />� BUILDING <br />MAx.00C.LOAD <br />PLUMBING <br />FIRE SPRINKLERS MECHANICAL <br />REOUIRE� <br />[ YES �:NO <br />�C <br />rte <br />��'�r,��� <br />��';�}tYrI��m <br />� •��� 'W� <br />' . w T "i <br />; �1� I•ii . � <br />a• c� �� <br />� ���i��.., .: 1 � <br />��1�'��.�, �!�. •'1 1 1 : 1 1 <br />g�p(; S2$3.00 <br />DATE OTHEH public Works �� V•W 20 � <br />PENALTY �' � <br />S . 1 <br />TOTAL gND II s'TO.� 363 00 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED pN 7HICSAACE) THI�X�R PERMIT .�� <br />bC11GM1 <br />Basic 1096 1171-5 4813.00 �= r <br />��� i �-.; <br />�� �.� U <br />FOR ISSUANCE BY (�(,'� S��•� � � � <br />ADDRESS FILE <br />