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the Evergreen CITY OF CONSTRUCTION <br />everett PERMIT PERMIT NO. O�548 <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 2 COMBINATION ® BUILDING U MECHANICAL EXI PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />TransLander P.O. Box 2996 Everett 98203 355-1703 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <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 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE! <br />CLASS OF WORK <br />MEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />$ 31,000.00 <br />Construct Single Familv Residence <br />PROPOSED USE OF BUILDING <br />Single Family Residence <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 RE 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 />CoNSTR CTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAT E CONTRA OR AUTHORIZ D AGENT DATE <br />6/_ /80 <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT 15-16BLOCK 452OF Saint Nicholas <br />H 2O-29-5 <br />-JOB ADDRESS <br />3208 21st Street <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />1 <br />WATER CLOSET (TOILET) <br />7 <br />nn <br />AIR COND.I VITS -H.P. EA. <br />_ <br />1 <br />BATHTUB <br />9 <br />nn <br />REFRIGERA' N UNITS - H.P. EA <br />1 <br />LAVATORY (WASH BASIN) <br />2 <br />001 <br />BOILERS - rI P" EA" <br />SHOWER <br />GAS FIRED A.C. UNITS - TONNAGE EA. <br />1 <br />KITCHEN SINK 8 DISP. <br />2 <br />on <br />FORCED AIR SYSTEMS - B.T.U. M EA, <br />1 <br />DISHWASHER <br />2 <br />00 <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS - B.T.U. M <br />1 <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />1 <br />WATEF. HEATER <br />CLOTHES DRYERS <br />3 <br />00- <br />URINAL <br />1 <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />1 <br />RANGE HOOD <br />3 <br />00 <br />FLOOR DRAIN <br />AIR HANDLING UNIT - C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS - RAINLEADERS <br />JL <br />METAL FIREPLACE 8 CHIMNEY <br />3 <br />00 <br />SINK (SERVICE - BAR. ETC) <br />SUB TOTAI <br />14 <br />SUBTOTAL $ <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />$ <br />14 <br />TOTAL FEE $ <br />11 <br />00 <br />SIDE YARD SETBACK <br />r <br />(5)-S & (10 ) <br />STREET SETBACK <br />20 T <br />REAR YARD SETBACK <br />r <br />20 <br />PLAN CHECK NUMBER <br />80/7548 <br />PLAN CHE" <br />FEE 19.00 <br />46.00 <br />K FEE <br />44Q, i4PNO. <br />46340 <br />USE ZONE <br />R-2 <br />LOT AREA <br />6200 Sq. Ft. <br />VACANT SITE <br />XXES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />V-N <br />OCCUPANCY GROUP <br />R-3 <br />NO. OF DWELLING UNITS <br />1 <br />BUILDING <br />S 31,000. <br />130 <br />00 <br />SIZE OF BLDG. <br />24' x34' <br />NO. OF STORIES <br />1 <br />MAX. OCC. LOAD <br />PLUMBING <br />14 <br />00 <br />FIRE ZONE <br />3 <br />BASEMENT <br />RORe <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES <br />MECHANICAL <br />11 <br />00 <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U BC. <br />SEC. 303 (a) <br />2. BUILDING PLANS ^T <br />TOTAL <br />15.5 <br />1 00 <br />3. FIRE HYDRANT +J <br />4. FIRE PROTECTION SYSTEM <br />- <br />I5. GRADING = <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE)THIS IS YOUR PERMIT <br />7 (' <br />CC /± 9 I I 130.00 <br />�] Lf7 <br />J YO U R K LECE' ff O <br />R RECEIPT THANK YOU <br />YCU <br />sB. DRAINAGE 0 <br />. ENVIRON_M AL IMPACTjTATEMENT <br />8 HEALTH DISTRICT <br />09 <br />C7IPPLICA7 tN A BY <br />�°, 1 <br />c ° <br />NS CHECKED BY <br />v.c. <br />APPR. FOR ISSUAN E Y <br />�l <br />TNA!dK <br />4-111 ADDRESfS FILE, _ _ <br />-3JW80 <br />1 <br />