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thtEvergreen � �CONSTRUCTI� <br /> pTY OF <br /> everett PERMIT PEST No. 15820 <br /> CITV HALL 25987t5 <br /> EVERETT,WA98201 ❑ COMBINATION ❑ BUILDIN(i ❑ MECHANICAL ❑ PLUMBIN(i <br /> OWNER MMLADDHESS CITY ZIP PMONE . . <br /> Dean H. Dragoo 1912 23rd St Everett 96201 252-7518 <br /> •RCHITECT OR DESiGNEfl MAIL AD�RESS GITV ZIP PHONE <br /> GENERAL CONTfl�CTOR MAIL AD�REU GTY 21P PHONE LICENSE 0 <br /> MECHANICAL CONTflACTOR MAIL ADDRESS GTY ZIP PMONE LICENSE• <br /> PWMBING CONTNACTOR MAIL AOORESS CITY ZIP PHONE LICENSE� <br /> CUSS OF WORK <br /> ❑ NEW ❑ ADDITION ❑ ALTEFRTI04 ❑REPAIR L� DEMOLITION ❑ FENCE ❑ SIGN � WOOD STOVEIFIREPLACE INSERT <br /> VALURTION OF WORK <br /> f <br /> DESCRIBE WORK <br /> Trash-burning stove <br /> PROPOSED USE OF BUILDING <br /> Single family residence I HEREBY CERTIFY TF1AT I HAVE READ AND EXAMINED THIS <br /> LEGFL DESCRIPTION OF PROPEFITY(SHOW BELOW OR ATfACH FOUfl COPIES� APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> �ot_a�ocK_oF GOVERNING T' IS TYPE OF WORK WILL 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 CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. <br /> JOB AUORE55 SIGNA E OF CONTRACTOR OR ORIZEO AGENT OATE <br /> 1912 - 23rd St X 12/16/85 <br /> PLUMBrNG MECHANICAL <br /> NO. TVPE OF FIXTURE OH ITEM FEE NO. TYPE OF EUUIPMENT FEE <br /> WATERCLOSET(TOILE7) AIR COND. UNITS— H.P. EA. <br /> BATHTUB REFRIGEFATIpN UNITS — H.P. EA. <br /> LAVATORY�WASH BASIN) BOILERS— H.P. EA. <br /> SHOWER GAS FIRED A.C.UNITS—70NNAGE EA. <br /> KITCHEN SINK 8 DISP. fORCED AIR SYSTEMS— B.T.U. M EA. <br /> DISHWASHER 1h'ALL HEATERS— B.T.U. M <br /> LAUNDRYTRAY UNIT HEATERS— B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE -WOOD J SO <br /> ROOF DRAINS— RAINLEADERS METAL FIREPLACE 8 CHIMNEY <br /> SINK(SERVICE— BAR, ETQ) FIREPLACE INSERT <br /> HEAT PUMP <br /> SUB TOTAL i SUB TOTAL S <br /> PERMIT f PERMIT S <br /> TOTAL FEE S TOTAL FEE S <br /> SI�E VARD SETBAGK STREET SETBACK REAR YAR�SETBACK PLP.N CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE 20NE LCT AREA VACANT SITE � <br /> !�YES i�.NO FEES VALUATION FEE <br /> NPE OF CONST. OGCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING S <br /> SIZE OF BLDG. NO.OF STORIES MAX.OCC. LOAD <br /> PLUMBING <br /> FIREZONE BASEMEIJ7 FIRESPRINKLERS MECHANICAL LJ SO <br /> REOUIRED <br /> :_YES :::NO <br /> APPROVALS BY DATE O7HER <br /> 7. ENVIRONMENTAL CHECK LIST PENALTY U.B.C. <br /> SEC.303(a) <br /> 2.BUILOING PLANS <br /> 3.�IREHYDRANT TOTAL IJ SO <br /> 4.FIRE PRO7ECTION SYSTEM PENMIT VALIDATION <br />�I 5.dRADING WHEN PROPERLY VALIDATED(IN THIS(P7 31�HIS IS�.Y(�U���I� Q� <br /> B.DRAINAGE } U <br /> 7.ENVIRONI.IENTALIMPACTSTATEMENT � <br /> � <br /> B.MEALTH DISTRICT �� � � �� i�:I.:C E l P M"� <br /> APPLICATION ACC.BY PLANS CHECKED 8Y APPR.FOR ISSUANCE BY -� " '` <br /> . ; �,, ,�,�, U <br /> M.M. <br /> � (� �cC �5 <br /> ADDRESS FILE <br />