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F <br />A <br />d1e Evergreen <br />CITY OF <br />everett <br />CITY HALL 259.0745 <br />EVERETT. WA 98201 <br />CONSTRUCTION <br />PERMIT PERMIT NO. 09434 <br />❑ COMBINATION ❑ BUILDING © MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />OSCAR PONG 5508 114th St. Ct. S. W. TACOMA 98299 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS Cltt ZIP PHONE LICENSE # <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE# <br />_ RTFNFR PTA(:_ <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE OCENSEs <br />_w ONEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEM( LITION ❑FENCE ❑SIGN ❑GARAGE <br />E <br />E WORK <br />MOTEL <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO 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. T-�E GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AG `HORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CANT CTOR OR AUTHORIZED AGENT DATE <br />X 6/26/81 <br />LEGAL DESCRIPTION OFPROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT RLOCK_ _OF <br />JOB ADDRESS <br />9602 19th Ave. S. E. <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 />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />A <br />CLOTHES DRYERS <br />18 <br />00 <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DH\IN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />ISTOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE E CHIMNEY <br />_ <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />E <br />PERMIT S <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 <br />FEE <br />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 />$ <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 />❑YES ONO <br />MECHANICAL <br />no <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U.B.C. <br />SEC. 303(a) <br />POO <br />2. BUILDING PLANS <br />TOTAL <br />21 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />. m� <br />06. <br />l� 41:3- <br />6) <br />CD <br />DRAINPGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />1C <br />I'. `! ?, 1 <br />