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the CITY <br />OF Eve <br />rgreen <br />'; O N S�T R U GT I O V <br />CITY OF �� <br />everett PERMIT PERMIT NO. 13771 <br />CITY HALL 259 8745 <br />EVERETT, WA 96201 ❑ COMBINATION ®C BUILDING MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS C-Tv ZIP PHONE <br />Church of Jesus Christ LDS 9509 19th Avenue S.E. Everett 98204 <br />ARCHITECT OR UESIGNER MAIL ADDRESS PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEN <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ALTERATION ❑REPAIR ❑ DEMOLITION ❑FENCE ❑SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />X$OJii ydu 10,300.00 <br />Construct 12'x16' Storage Bui <br />LOT_SLOCK__OF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PHESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCo�yyLL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />JOB ADDRESS <br />SIG <br />TURL OF LAN I G UH AU I HumccU Apt"$ <br />�V <br />9809 19th Avenue S.E. <br />X <br />PLUMBING <br />MECHANICAL <br />NO. <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 />LAUNDRY TRAY <br />UNIT HEATERS - B.T.U. M <br />- <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 BRAIN <br />AIR HANDLING UNIT - C.F.M. <br />VACUUM BREAKERS <br />STOVE - WOOD <br />- <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE - BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />I <br />SUB TOTAL <br />S <br />SUBTOTAL <br />5 <br />PERMIT <br />S <br />PERMIT <br />S <br />TOTAL FEE <br />S <br />TOTAL <br />FEE <br />5 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />84/13771 <br />FEE 40.63 <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />I <br />LIVES UN0 <br />10.'i In - <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />V-N <br />N <br />N/A <br />BUILDING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX, OCC, LOAD <br />PLUMBING <br />192 Sq. Ft. <br />1 <br />N/A <br />F19E ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />MECHANICALREOUIRED <br />- <br />_YES EGO <br />OTHER <br />Ah'ROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC.. 1) <br />86 <br />50 <br />_ <br />2. BUILDING, PLANS <br />TOTAL <br />g <br />�� <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED QN THIS SPAC? THIS <br />IS YOUR,PERMIT <br />5. GRADING <br />__,--I <br />�. <br />(Y) <br />Y-4 <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />6. HEALTH DISTRICT <br />MLCUANCEBY <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />_ <br />_T <br />J <br />S TG <br />H1111 <br />-I n <br />Tn <br />to <br />O <br />om <br />nm <br />c V, <br />m r, <br />m <br />L �> <br />m <br />m <br />a <br />A <br />D <br />z ' <br />2 ' <br />LA <br />N <br />ADDRESS FILE <br />