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the Evergreen <br />CITY OF 41PONSTRUCTIO16 <br />everett PERMIT <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 ❑ COMBINATION ❑ BUILDING RR MECHANICAL <br />0 <br />PERMIT NO. 15625 <br />❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Douglas Fordham 9509 7th Avenue S.E. Evezett 98204 355-1875 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 7 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />Same <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />VALUATION OF WORK. <br />S <br />DESCRIBE WORK <br />Install wood Stove <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <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 PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE 09 <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OFF CONSTRUCTION. <br />SIGN TARE OF C NTRACCT R pR AUT ZED AGENT DATE <br />Cja— 10/25/85 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT -BLOCK -OF <br />JOB ADDRESS <br />9509 7th Avenue S.E. <br />PLUMBING <br />MECHA ICAL <br />NO. <br />_ TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />WATER CLOSET( TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY )WASH BASIN) <br />BOILERS — H.P. EA. <br />RFEE <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />KITCHEN SINKS DISP. <br />FORCEU AIR SYSTEMS — B.T.U. M EA. <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 />1 <br />STOVE —WOOD <br />7 <br />So <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE d CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />in <br />nn <br />TOTAL FEE $ <br />TOTAL FEE S <br />SIOF YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES _NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REOUIRED <br />."!YES -NO <br />MECHANICAL <br />17 <br />50 <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />50 <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />17 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THI�l %P") THIS$S6'C{ jF �@IT— .4 <br />ISO U R R E C E I PT'-" <br />SHANK YOU <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />25OCT 85 <br />ADDRESS FILE <br />