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Me Evergreen <br />CITY OF <br />evereit <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 <br />10 CQ#STRUCTION 09 <br />PERMIT PERMIT NO. 06409 <br />® COMBINATION KI BUILDING E MECHANICAL ® PLUMBING <br />MAIL AouHE5S <br />CITY <br />ZIP <br />98203 <br />391-4120 <br />OWNER <br />Steven R. Klein <br />4924 33rd Ave. West <br />ARCHITECT OR DESIGN__R <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />659-0815 <br />Keta Construction <br />21P <br />PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />KE TA AC 288DV <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSEF <br />PLUMBING CONTRACTOR <br />CLASS OF WORK <br />❑NEW KD4DDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION []FENCE ❑SIGN OGARAGE <br />$ 35,000.00 <br />DESCRIBE WORK a 4 A e r p <br />ACIQiriOIt Lou a+...y+-.- +. .....--i ----- <br />PROPOSED USE OF BUILDING <br />family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />Single <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />LEGAL DESCRIPTION OF PROPERTY (SHOP/ BELOW OR ATTACH FOUR COPIES) <br />`YDT74 1x�4 GF Shore Acres <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />64T=15— 3 <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CON TRUCTION THE PERFORMANCE OF CONSTRUCTION. <br />511NAT RE OF CONT TOR AUTHORIZED AGEN DATE <br />7/ 2 4/ 7 9 <br />JOB ADDRESS <br />4924 33rd Ave. West <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />4 <br />00 <br />AIR COND. UNITS - H.P. EA. <br />WATER CLOSET (TOILET) <br />BATHTUB <br />REFRIGERATION UNITS <br />BOILERS - H P. EA. <br />2 <br />LAVATORY (WASH BASIN) <br />2 <br />O <br />GAS FIRED A.G. UNITS -TONNAGE EA. <br />1 <br />SHOWER <br />FORCED AIR SYSTEMS -B.T.U. M EA. <br />I <br />KITCHEN SINK 8 DISP. <br />WALL HEATERS - B.T.U. M <br />1 <br />DISHWASHER <br />2 <br />UNIT M <br />1 <br />LAUNDRY TRAY <br />2 <br />00 <br />EVAPORATERS-B.T.U. <br />EVAPORATIVE COOLERS — <br />CLOTHES WASHER <br />2 <br />00 <br />CLOTHES DRYERS <br />00 <br />1 <br />\WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT - C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE &CHIMNEY <br />ROOF DRAINS - RAINLEADERS <br />SINK ISERVICE - BAR. ETC,) <br />SUBTOTAL $ 3 00 <br />22 <br />00 <br />SUB TOTAL <br />PERMIT S <br />PERMIT <br />$ <br />0 0 <br />TOTAL FEE S 3 00 <br />TOTAL FEE <br />$ 22 <br />PLAN CHECK FEE <br />PLAN CHECK NUMBER RECEIPT N0. <br />0 SIDE YA9VTBAGK <br />STREET SETS �CK <br />REAR Yjg SETBACK <br />/'i <br />2b <br />FF11.00 <br />79/336 a9a53 _ <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />AYES i➢1!i0 <br />FEES <br />VALUATION <br />FEE <br />R-S <br />TYPE OF CONST. <br />OCCUPANRCY GROUP <br />NO. OFOK'ELLING UNITS <br />1 <br />BUILDING <br />$ 35 1000. <br />142 <br />00 <br />V-N <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />SIZE OF BLDG, <br />22 <br />00 <br />3' x54' 6' x63' <br />1 <br />PLUMBING <br />FIRE ZONE BASEMENT <br />FIRE SPNKLERS <br />RE UIIRDYES BDNO <br />MECHANICAL <br />3 <br />00 <br />3 yes <br />APPROVALS <br />BY DATE <br />OTHER <br />PENALTY <br />;303 (a) <br />IEC. <br />_ <br />1. ENVIRONMENTAL CHECKLIST <br />2. BUILDING PLANS <br />TOTAL 167 00 <br />3, FIRE HYDRANT - 00 <br />4. FIRE PROTECTION SYSTEM <br />'" <br />PERMIT VALIDATION y3 <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR �EjitJ�T A O ,ro <br />7 Y 1 i 6 <br />5. GRADIN4 <br />_'^ <br />r <br />r- DRAINAGE G M <br />� <br />S.O ry. p'�C <br />v©V R RECE�L Lj <br />V <br />7 ENVIROyML�RAL IMPA TATEMENT <br />` <br />HEALTRmI$i:ACT 1./1 <br />K Y01) C <br />71-1AN <br />_ <br />PPLICAT1Lj(J . BY DLANS CHECKED BY <br />APPR. FOR ISSUA�IC6 <br />U R RECEIPT - . <br />i.ANK YOU a �• .. . <br />