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the EvCTY OF Cry NSTR U CTIO N <br />everett PERMIT PERMIT NO.06342 <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />1st premium Homes 221 South Broadway 98204 353-5080 <br />OR DESIGNER <br />MAIL ADDRESS <br />ZIP <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE# <br />Same <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE 1 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE( <br />vV�V V ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR El DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VAWATiON OF WORK 6�' <br />$ 10,000 9Q. Yds. fill <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TG BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <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 />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CO UCTION OR THE PE OF MANCE OF CONST <br />51 ATU OF CON i Z D ; DATE <br />&$&B%sX <br />LAO <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOi BLOCK_OF <br />SWk NW�i of SW�4 17-28-SEWM <br />JOB ADDRE S <br />9 05 19th Avenue S.E. <br />PLUMBING <br />MECHAN L <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 />_ <br />KITCHEN SINK S DISP, <br />FORCED AIR SYSTEMS - STE! M EA. <br />DISHWASHER <br />WALL HEATERS - B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS - B.T.U. M <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 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, ETCJ <br />SUBTOTAL <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />S <br />TOTAL <br />FEE $ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE aO % <br />FEE <br />RECEIPT NO. <br />��ss <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VAWATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$10 , 000 <br />132 <br />00 <br />SIZE OF BLDG. <br />NO, OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />USE.3 C. B C. <br />U3 (al <br />- <br />2. BUILDING PLANS <br />TOTAL <br />132 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />9324 S 13 1. 0 0 <br />Cy') <br />e p <br />:YO;Uft R EY EIPT cD <br />Tt-IMI YOU <br />I <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />6, HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECK'cD BY <br />APPR. FOR ISSUANCE BY <br />1 <br />