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21 <br />7,IB EVC' <br />CITY - C7NSTRUCTION <br />CITY OOF <br />everett PERMIT PERMIT NO. 09606 <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER <br />MAIL ADDRESS <br />C!TI <br />ZIP <br />PHONE <br />Jack Gobel <br />4919 33rd Avenue West <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE 1 <br />MECHANICAL CONTPACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CTY <br />ZIP <br />PHONE <br />LICENSE <br />OF WORK <br />❑NEW XMADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />1 4,000.00 <br />CRIBE WORK <br />Addition to existiTg garage <br />PIfJPOSED USE OF BUILDING <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 H T E-'G ING OF A PERMIT DOES NOT <br />PRESU E AUTHO TO LATE OR CANCEL THE PRO. <br />0 AlY OTH STAT OR LOCAL LAW REGULATING <br />ONST CTION OR E PERFO M OF CONSTRUCTION. <br />SIGNA RE OF CONTW4TOR R A THORIZED DATE <br />X 8/1 81 <br />LFGAL DESCRIPTION OF FBOPERTY(SHOW BELOW OR ATTACH FOUR COPIES) <br />5 2 Shore Acres <br />LOT BLOCK- <br />JOB ADDRESS <br />4919 33rd Avenue West <br />PLUMBING <br />MECHANICA <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPM <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTI.IB <br />REFRIGERATION UNITS — H.P. EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. _ <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK 8 DISP. <br />'ORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />'MALL HEATERS — B.T.U. M <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 />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIII <br />RANGE HOOD <br />FLOOR DRAIN <br />I AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />SUBTOTAL $ <br />_ <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />81/9606 <br />PLAN CHECK <br />FEE 28.93 <br />FEE <br />RECEIPT NO. <br />AAqOA — <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES R%O <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />V-N <br />OCCUPANCY GROUP <br />M-1 <br />NO. OF DWELLING UNITS <br />1 <br />BUILDING <br />S 4,000. <br />44 <br />50 <br />SIZE OF BLDG. <br />' 1 611x191 all <br />NO OF STORIES <br />I <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REOUIP.EO <br />(/YES V. 0 <br />MECHANICAL <br />_ APPROVAL'i <br />BY <br />DATE <br />C'HER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC. <br />SEC. 303(a) <br />2. BUILDING PLANS <br />TOTAL <br />44 <br />50 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />."MEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PER.97 <br />I LO <br />C:) <br />CC) <br />CC)D <br />-- <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHE]KED BY <br />APPR. FOR ISSUANCE BY <br />