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Me Evergreen <br />CITY OF <br />everett <br />CITY HALL 2596745 <br />EVERETT. WA 98201 <br />CONSTRUCTION' <br />PERMIT <br />® COMBINATION ® BUILDING l-] MECHANICAL <br />PERMIT NO. 142 %O <br />0 PLUMBING <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />M.D. Fordham <br />9509 7th Avenue <br />Everett <br />98204 <br />355-1975 <br />ARCHITECT OR DESIGNER <br />_ <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CE14ERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Van Rossen Const. 3316 107th Street S.E. Everett 98204 337-2865 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CI fY ZIP PHONE LICENSEN <br />VANROC234L9 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑ NEW RKADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEFIREPLACE INSERT <br />$ 19,Sn0.00 <br />(T.-.ten 4v..rM 9A1 - Irl AAAi*ian 1'h GVI C}'lTrt Y^aia^npp <br />PROPOSED USE OF BUILDING <br />Single Family Residence <br />I HEREBY CERTIFY THAT I HAVE READ > EXAMINED TH'S <br />T <br />APPLICATION AND KNOW THE SAME TO BE TRUE AI.. <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRE` ME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS 0 ' r ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PER MANCE OF CONSTRUCTION. <br />SIGNAT E OF CONTRACTO THORIZ ENT DATE _ <br />5 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT_BLOCK__OF <br />West 195' of S> Sit SW� SW� Exc W 30' for <br />RD Also Exc N 60' <br />_ <br />JOB ADDRESS <br />9509 7th 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 />1 <br />WA TER CLOSET(TOILET) <br />2 <br />00 <br />AIR COND. UNITS - H.P. EA. <br />1 <br />BATHTUB <br />2 <br />00 <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY(WASH BASIN) <br />2 <br />00 <br />1 <br />BOILERS - H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS - TONNAGE EA. <br />1 <br />KITCHEN SINK & DISP. <br />no <br />FORCED AIR SYSTEMS - B.T.U. M EA, <br />DISHWASHER <br />WALL HEATERS - B.T.U. M <br />LAUNDiYTRAY <br />UNIT HEATERS - B.T.U. M <br />1 <br />CLOTHE -WASHER <br />2 <br />00 <br />EVAPORATIVE COOLERS <br />1 <br />WATER HEATER <br />2 <br />00 <br />1 <br />CLOTHES DRYERS <br />4 <br />50 <br />URIN4L <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />I 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 />_ <br />-- <br />HEAT PUMP <br />SUB TOTAL <br />+ <br />12 <br />00 <br />SUB TOTAL $ <br />4 <br />50 <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />12 <br />00 <br />TOTAL FEE f <br />50 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />84/14260 <br />PLAN <br />FEE 9133 <br />CHECK FEE <br />0. <br />RE &ig <br />USE ZONE <br />R-1 <br />LOT AREA <br />VACANT SITE <br />;;YES X710 <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 />$19,500. <br />140 <br />50 <br />SIZE OF BLDG. <br />960 Sq. Ft. Add <br />NO. OF STORIES <br />1 <br />MAX. OCC. LOAD <br />4 <br />PLUMBING <br />12 <br />00 <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIREOYES :.NO <br />MECHANICAL <br />4 <br />50 <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />_ <br />PENALTY <br />U.B.C. <br />SEC. 303 (B) <br />2. BUILDING PLANS <br />TOTAL <br />157 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5.GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT %' <br />CC <br />(� <br />r <br />6. DRAINAGE <br />7; ENVIRONMENTAL IMPACT STATEMENT-! <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />ES <br />7PLANS CHECKED BY <br />JEF <br />APPR. FOR ISSUANCE BY <br />LC <br />/ <br />ADDRESS FILE -,I ': <br />