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rheEi�ergreen - ��NST�UCT'101\ ' <br />CI?Y OF <br />everett PERMIT pERMIT NO.OHO75 <br />CITY HALL 259�8745 <br />EVERETT. WA 98201 ❑ COM1IBINATION C�c,�BUILDING ❑ MECHANICAL ❑ PLUMBING <br />JWNEH !.IqILqODRE55 CIiY ZIP PMONE <br />F. B. Nelson 4934 27th Avenue Everett 9A203 355-8844 <br />AFCHITECT 9R �ESIGNER MAIL FD�RE55 CIiY ZIP PHONE <br />G[NEfiAI CONTRwCTOP. MNIL FDOflE55 GTY :JP PMOHE LICE1lSE / <br />Same <br />MECHANICALCONTPACTOR MAIL/GCFE55 CITV ZIP PHONL �.IGENSEI <br />PLUMpING CONiflACTOR MAIL ADOFE55 CITY ZIP PMONE LICENSE I <br />❑NEW ❑ADDITION ❑AUERATION �}iiEPAIR ❑�EMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION 0` WORK <br />s 45C�0.00 <br />OESCR�BE WORK <br />re-roof---shaka <br />PROPOSED USE OF BU�LUING <br />single family residence <br />LEGhL DESGRIPiION OF PRGPEflTY �SHO\V BELOW ON ATTACH <br />LO�_ BLOC�_OF <br />Sec 34 Twp 29 Rge 04 <br />JOB AD�RESS <br />4934 27th Avenue West <br />PLUMBING <br />N0. TYPE OP PIXTURE OR ITEM <br />WATER CLOSET QOILE O <br />BATHTUB <br />LAVATORYIWASH OASIN) <br />SHOWER <br />KITCHEN SINR & DISP. <br />DISHWASHER <br />LAUNORVTRAY <br />CLOTHES WASHER <br />WATER hiEATER <br />URINAL <br />CRINKING FOUNTAIN <br />FLOOR JRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RPINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />SIDE YARD SETBACK � STREET SETBACK <br />USE ZONE l0T AREA <br />TYPEOFCONST. OCCUPAN <br />S�LE OF BLDG. N0. OF Sl <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING �LANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DIS7RICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW i HE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WIL� BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORII'Y TO VIOLATE OF CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR I.00AL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />61GNATUF'E �OF CO�Ni7RACiOR OR AUTMORiZED AGENT DATE <br />X�/�/G //�2....�.� 8�8�80 <br />MECHANICAL <br />FEE N0. <br />REAR YARD SETBACK IPLAN <br />f 1VES ❑NO <br />N0. OF DN'ELLIN6 UNIT$ <br />APPR. POR I.SSUANCE B" <br />GAS FIPED A.C. UI <br />FORCE� AIR SYST <br />WALL HEATERS — <br />UNIT HEATERS — <br />EVAFORATIVE CO( <br />CLOTHES DPYERS <br />VENTILATION FAN <br />— k3.T'U ^u L^M EA. <br />HIR NANDLING UNIT — <br />M <br />QF <br />METAL hIHhPLAGE d CHIMNEV <br />BUILDItJG <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE <br />= 4500 <br />U.B.C. <br />SEC. 303 (a) <br />FEE <br />RECEIPT NO. <br />321 00 <br />321 00 <br />PEHMIT VALIDATION <br />WHEN PROPERLV VALIDATED (IN THIS SPACF) THIS IS YOUR PERMIT <br />6oii $032.00 - � <br />0 <br />� <br />1'':��UR R.F_CEIPT � <br />tl�f\�K YC�U <br />