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the Evergreen <br />CONSTRUCT 101 <br />CITY of <br />_ <br />everett <br />PERMIT <br />PERMIT NO.09015 <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 <br />I�,� <br />El COMBINATION aBUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />OWNER <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />Oscar Pong <br />5508 114th St. Court S.W. Tacoma, <br />98499 582-2978 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE LICENSE <br />W. F. Brenner 10895 S.W. 5th Beaverton, Oregon <br />97005 643-5721 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE LICENSE <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />S 6,000.00 <br />DESCRIBE WORK <br />Foundation only <br />PROPOSED USE OF BUILDING <br />Motel <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION ANC 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, THE GRANT P OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHOR VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTH ST OR LOCAL LAW REGULATING <br />CONST ION OR E P FORMAN OF CONSTRUCTION. <br />SIGNAT COT UTHORIZED AGF DATE <br />X 3/19/81 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LDT BLDCK_GF <br />SE% 18 28N 5EWM <br />OR ACURESS <br />9602 19th Avenue S.E. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF ECU ENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS - H.P. EA. <br />BATHTUB <br />_ <br />_ <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 />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, ETC.) <br />SUBTOTAL <br />SUBTOTAL E <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />81/8931 <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />— <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />V-N <br />OCCUPANCY GROUP <br />R-I <br />NO. OF DWELLING UNITS <br />120 <br />BUILDING <br />$ 6,000. <br />56 <br />50 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />2 <br />MAX. OCC. LOAD <br />2 <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />None <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES VNIO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMEN iA: CHECK LIST <br />PENALTY <br />U BC <br />SEC. 303(a) <br />2. BUILDING PLANS <br />TOTAL <br />56 <br />50 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />PERMIT VALIDATION <br />WI(EN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />c <br />C <br />' ' T_^ _ C E Ip_ <br />F I (_ <br />' �`"; YO U <br />6. DRAINAGE-- <br />T ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />HWM <br />APPR. FOR ISSUANCE BY <br />1 <br />ADDRESS FILE <br />