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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 <br />CONSTRUCTICN <br />PERMIT <br />❑ COMBINATION ❑ BUILDING MECHANICAL <br />PERMIT NO. 15779 <br />J PLUMBING <br />OWNER MAIL ADDRESS CTY :iF PHONE <br />z Marylou Nye P.O. ROX 127 Freeland 98249 321-5045 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A' <br />❑ NEW ❑ ADDITION O ALTERATION ❑ REPAIR O DEMOLITION ❑ FENCE ❑ SIGN HX WOOD STOVE/FIREPLACE INSERT <br />E <br />Install wood stove <br />PROPOSED USE 017 BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION .AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS 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 S1ATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHCRIZED AGENT DATE <br />X L4-- 12/5/85 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT -BLOCK -OF <br />— <br />i <br />JOB ADDRESS <br />4722 33rd Avenue Nest <br />PLUMBING <br />MECHANICAL <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS -- H.P. EA. <br />LAVATORY(WASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS •- TONNAGE EA. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <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 />2 <br />STOVE — WOOD <br />ir <br />00 <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 3 CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />I FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL 3 <br />SUB TOTAL f <br />15 <br />00 <br />PERMIT 5 <br />i <br />PERMIT Son <br />TOTAL FEE S1 <br />ITOTAL <br />FEE S <br />25 <br />1 00 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />— <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <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 />❑YES ENO <br />MECHANICAL <br />25 <br />00 <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />TOTAL <br />U.B.C. <br />SEC. 303 (a) <br />25 <br />00 <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION Q <br />WHEN PROPERLY VALIDATED pN THLSTyf!PPQ FHI 1 l� IT <br />r" <br />r RICE iPT <br />_ <br />'I'O U <br />S. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />- 6 VEC 85 <br />ADDRESS FILE <br />