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the C•v CITYOF CONSTRUCTION <br />CITY OF <br />everett PERMIT PERMIT NO.09437 <br />CITY HALL 259 8-45 <br />EVERETT. WA b,201 ❑ COMBINATION M BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER <br />GRODT, PETER 619 <br />MAIL ADDRESS <br />- 33rd St. <br />CITY ZIP PHONE <br />Everett 258-1023 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />Seattle 622-5005 <br />Robert Barbee <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE LICENSE <br />Self <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE LICENSEI <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />❑NEW XWDDITION <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />s2500.00 <br />DESCRIBE WORK <br />Foundation only <br />PROPOSED USE OF BUILDING <br />Single Family Residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT 9&10 BLOCK 1 Y OF Rucker <br />Park Addn <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIO O ANY OTHER STATE OR LOCAL LAW REGULATING <br />CON TRU/ ION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN TC'.E l,'F CONTRA;: -OR A TNORIZED AGE)' <br />JOB ADDRESS <br />��OE <br />69/o1 <br />oy-' <br />619-33rd <br />X <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR <br />ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />All, COND. UNITS — H.P. EA. <br />BATHTUB <br />I <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 />_ <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS -- B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS -- B.T.U. M <br />- <br />......__.. __... <br />UNIT HFATERS -- RT. U. M <br />WATER <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 />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />_ <br />... .. �,,...I <br />SUB TOTAL $ <br />TOTAL FEE $ TOTAL FEE S <br />SIDE YARD SETBACK I STREET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE I RECEIPT NO. <br />USE ZONE <br />STORIES <br />ZONE <br />I. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />T. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY I PLANS CHECKED BY <br />I <br />LIVES ONO <br />FEES <br />VALUATION <br />FEE <br />50 <br />NO. OF DWELLING UNITS <br />BUILDING <br />2500.00 <br />38 <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS _ <br />REQUIRED <br />DYES ONO <br />MECHANICAL <br />50 <br />OTHER <br />By <br />DATE <br />PENF :TV <br />U.B C. <br />SEC. 303 (a) <br />TOTAL <br />38 <br />— <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS <br />SPACE) THIS IS YOUR <br />12 <br />PERMIT <br />038.50 <br />--Ml <br />Ij <br />APPR. FOR ISSUANCE BY <br />KWC <br />ADDRESS FILE <br />