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the Eve, <br />e CITY OF O N ST R U CT I O N <br />_ everett PERMIT PERMIT NO.09256 <br />CITY HALL 259-8745 <br />I EVERETT. WA 98201 ❑ COMBINATION ®XBUILDING ❑ MECHANICAL ❑ PLUMBING <br />Bill Brenner 10895 S.W. 5th Beaverton 97005 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONL <br />GENERAL CONTRACTOR <br />MAIL ACDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />Crown Gunite Const. <br />12000 S.W. Tongguin <br />Sherwood <br />Ore 97040 <br />638-7604 <br />FMECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />CR OW <br />NG C280QP <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSED <br />L <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION El FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />s 10,000. <br />DESCRIBE WORK <br />INSTALL SWIMMING POOL <br />PROPOSED USE OF BUILDING <br />Motel Pool <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. 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 />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK ---OF <br />JOB ADDRESS <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 EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNIT& — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA,, <br />_ <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 FIHEPLACE A CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />SUBTOTAL $ <br />PERMIT <br />S <br />PERMIT $ <br />_ <br />TOTAL FEE <br />$1 <br />TOTAL FEE E <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 />❑YES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$10,000. <br />50 <br />QO <br />SIZE OF BLDG, <br />N0. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPPINKLERS <br />REQUIRED <br />❑YES LINO <br />MECHANICAL <br />_ <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />50 <br />00 <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS 5PACE) THIS IS;YOUR, PERMIT <br />Ln <br />CV <br />(7) <br />CD <br />i <br />— <br />8. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILE <br />1 � i <br />