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the EcO CITY ; <br />OFF ONSTRUCTION`- - <br />CITY I <br />everett PERMIT PERMIT NO. 16538 <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />LDS Church 45C�cl -9505 9th Ava G F Everett <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE 0 <br />Everett Builders <br />5606 Evergreen Way <br />Everett <br />98203 <br />353-7161 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE N <br />EVEREB311L3 <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE II <br />❑ NEW ❑ ADDITION ❑ ALTERATION IQ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />52,175.00 <br />ESCRIBE WORK <br />olrame in for door <br />ROPOSED USE OF BUILDING <br />church <br />COAL DESCRIPTION OF PROPEF <br />LOT -BLOCK _OF <br />17-2B-05 <br />PLUMBING <br />ATTACH FOUR <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 PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNAT RE OF CONTRACTOR OR AUTHORIZED AGENT I DATE <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 8 DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />71 <br />DISHWASHER <br />WALL HEATERS - B.T.U. M <br />LAUNDRYTRAY <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 FOUNTAW <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT - C.F.M. <br />VACUUM BREAKERS <br />ROOF DRAINS - RAINLEADERS <br />STOVF - WOOD <br />METAL FIREPLACE S CHIMNEY <br />SINK (SERVICE - BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL <br />B <br />SUB TOTAL <br />S <br />PERMIT <br />$ <br />PERMIT <br />S <br />TOTAL FEE <br />S <br />TOTAL FEE <br />9 <br />- <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />FEE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />YES .-NO <br />FEES <br />VALUATION <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />52, 175.00 <br />38 <br />SO < <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />_ <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />YES NO <br />MECHANICAL <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.SC. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />38, <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS.SPACE) THIS 16 IYOU f� UP JBRUMI T— <br />0 J U <br />Ln <br />co <br />&GRADING <br />B. DRAINAGE <br />7. ENVIRONMENTAL IMPALT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />