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APPLICATION FOR <br />CITY OF tho Ewrpm:E CONSTRUCTION <br />CITY <br />everett PERMIT Le <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />Manfred Bereens 804M33rdFSStreet Everett, 98201 PHONE597008 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GIMBAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />Everett Builders, Inc. 5606 Evergreen Way Everett 98203 353-7161 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />(223-01-EV-ER-EB-301 PH) <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />CLASS OF WORK <br />[:]NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGF ❑BUILDING RELOCATION <br />VALUATION OF WO <br />R+236 . 00 <br />$ <br />DESCRIBE WORK <br />Replace 30' foundation. Level house. Install 5' chain link fence around rear yard <br />PROPOSID USE OF RUILDINC <br />residential <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X �—.CP" �E^. <br />LECAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT -BLOCK_ Of ��5839-783-006-0001 <br />IDB ADDR804 33rd St. Everett, Wn. 98201 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIETI <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 . UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-8.T U M EA <br />DISWASHER <br />WALL HEATERS—B.T.0 M <br />LAUNDRY TRAY <br />UNIT HFATERS—B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WAIER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.FM. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC I <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT <br />S <br />PERMIT 3 <br />TOTALFEE <br />S <br />TOTAL FEE B <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES DNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />C <br />SIC. <br />SEC, 703(a1 <br />Z BUILDING PLANS <br />TOTAL <br />7 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINCII KCAVATION A CLEARINGICRUBBING <br />h DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED DY <br />APPR FOR ISSUANCE BY <br />91-79 <br />