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theEt'e/SYeOF � /ONSTRUCTlON� � �-��� <br /> everett PERMIT PERMIT NO. 09267 <br /> CITY HALL 259�8745 <br /> EVERETT,WA 98201 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ pLUMBING <br /> OWNER MAILAO�PESS GIiY pIP pMONE <br /> Virginia M. Dabney 10120 - 7th Avenue Everett 98203 353-4159 <br /> ARLNITECT OR DESIGNEP MAIL A90RE55 CITY TIP PMONE <br /> GENERALCONTPAf,tOF MAILP.ppRE55 CITv ZIP PHONE LICENSE/ I <br /> H & G Glass Co. 6502} Evergreen Way Everett 98?.03 353-8484 or 355-5443 <br /> MECNhNiCALCCYiPAQOR MAILFODRF55 CITY ZIP PHONE �ICENSE/ <br /> PLUMBING CONiPACTOR MAIL AppRESS CITV ZIP PHONE LICENSE 1 <br /> CLASS OP WORK <br /> UNEW ❑ADDIiION ❑ALTERATION �pEPA1R ❑DEMOLITIOI: C�FENCE ❑SIGN ❑GARAGE <br /> VALUATpION CF WORH <br /> S OOOO.00 <br /> DESCHIBE pOPK — <br /> Siding <br /> PROPOSE7 USE OF BUILDING <br /> I HEREBY CERTIFY Tfi.qT I HAVE READ AND EXAMINED THIS AP• <br /> LEGALOESCRipTIONOFPROPEflTY�SNOY/EELOWORAiTACMPOURCOPIES) PLICATION AND KNOW THE SAME TO BE TRU° AND CORRECT. <br /> �9 Broadwa Farms �2 ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> ioT e�ocr�oF TYPE OF WORK WILL BE COMPLIED WITH WHE?HER SPECIFIED <br /> E 324 ft less E 134 ft of S 150 ft HEREIN OR NOi. THE GRANTIhG OF A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLA.TE OR CANCEL THE`�RO� <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULAiING <br /> CONST4UCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> JOB ApDRE55 SIGNAiURE OF CANTRACiOR OR AU7NOPVED AGENT OAiE <br /> X___� �� <br /> \ j 7[i(�.. \ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTUHE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET QOII ET) AIR COND.UNITS--H.P.EA. <br /> BATHTU� REFRIGERATION UNITS—H.P.EA <br /> L4VATORY(WASH EASINI BOILERS—H.P EA. <br /> SHOWER GAS FIRED A.C.UNITS—TONNAGE EA. I <br /> KITCHEN SINK 6 DISP. FORCED AIR SYS7EMS--8 T.U. M[A. <br /> DISHWASHEF WALL HEATFRS—B T.U. M <br /> LAUNDRY TRAY UNIT HEATERS—B.T.U. M <br /> CLO7ME5 WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DNVERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DPAINS—RAINLEADERS METAL FIHEPUICE 8 CHIMNEY <br /> SINK ISERVICE—BhR,E7C.) <br /> SUBTOTAL SUBTOTAL S � <br /> PEXMIt S PEHMIT S <br /> TOTALFEE t TOTAL FEE S <br /> SIDE VARD SE7BACK STREET SE7BACK REAR VAPD£ETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE lCi AREA VACANT SITE j <br /> OYES ❑NO FEES VALUATION FEE I <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS I <br /> SIZE OF BLDG. NO.OF STORIES MAX.OCC.LOAD BUILOING $ $OOO.00 ES. 5O �I� <br /> PLUMBING <br /> FIRE ZONE BASEMENT FIRE SPRINKLERS <br /> REOUIRED MECHANICAL �� <br /> ']YES ❑NO <br /> APPNOVALS ' BY DATE OTHER �, <br /> 1. ENVIRONMENTALCHECKLIST PENALTY U.B.C. � <br /> 2. BUILDING PLANS SEC.3031a) <br /> 3. FIRE HYDRANT T�TA� ($ 50 <br /> 4. FIRE PROTECTION SVSTE41 PERMIT VALIDATION <br /> WHEN PROPERLY VALI�A7ED(IN THIS SPACE)THIS IS YOUR PERMIT <br /> 5. GRADING <br /> 6. DRAINAGE � _ � <br /> 7. ENVIRONMENTAL IMPACT STA7EMENT i f � 7 ^ ��^I � C r, <br /> B. HEALTH DISTRICT � <br /> APPLICATION ACC.B1" PLANS CHECiCED BY APPR.FOR ISSUANCE BY � .- � i;,�I � <br /> LC <br /> : J <br /> ADDRPSS FILE f I '"Y � I , <br /> � <br />