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the Evergreen <br />c1,1 CI <br />everett <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION <br />C0NSTRUCT101'" <br />PERMIT <br />❑ BUILDING MECHANICAL <br />PERMIT NO. 15613 <br />i- PLUMBING <br />OWNER MAIL ADDRESS Cin ZIP PHONE <br />Robert Langan 9501 7th Avenue S.E. Everett 98204 353-1081 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADURESS CITY ZIP PHONE LICENSE N <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />Natural Energy Systems, Inc. 15405 53rd Avenue S. Seattle 98188 431-1700 <br />CLASS OF WORK ��� <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR G DEMOLITION ❑ FENCE ❑ URKSW��nnrr,,�� "STOVEIFIREPLACE INSERT <br />VALUATION OF WORK <br />install Energy Management System <br />PROPOSED USE OF BUILDING <br />Single Family Residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL PROVISIONS OF LAWS AND CRDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A <br />PERMIT DOES NOT PRESUMETO GIVEAUTHORITYTO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X Check #3680 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIER) <br />LOT —BLOCK —OF <br />Section 18 TWP 28 RGE 05A Ney 4 SW4 Rt-9A <br />JOB ADDRESS <br />9501 7th Avenue S.E. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE 7r 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 />_ <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 />LAUNDRYTRAY <br />UNIT HEATERS - B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />1 <br />WATER HEATER <br />nn <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 -- WOOD <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE - BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL S2 <br />no <br />SUB TOTAL $ <br />PERMIT $ <br />3 <br />PERMIT S <br />TOTAL FEE t <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES :NO <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 />— <br />PLUMBING <br />5 <br />00 <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />YES ONO <br />MECHANICAL <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY "'S6C. <br />U.@.C. <br />303 (al <br />2. BUILDING PLANS' <br />TOTAL <br />5 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATIONp(� [ j(1� j(1� r <br />WHEN PROPERLY VALIDATED (IN THIS PFI FSEI)THIS I41Ty45EFU.t# (Yk <br />t"'I <br />y:D IS R REC E I F .. <br />r <br />THANK y O U <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACTSTATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. 7 <br />APPLICATION ACC. BY <br />PLANB CHECKED BY <br />APPR. FOR ISSUANCE BY <br />2 1. OCT t 5 <br />ADDRESS FILL <br />