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1 <br /> the Evergreen �''ON S T R U C TI O N <br /> r. ' everett <br /> CITY OF PERMIT <br /> everett <br /> CITY HALL 2698746 <br /> EV ER ETT,WA 911201COMBINATION • BUILDING • MECHANICAL • PLUMBING .e <br /> OWNER R/0 /ac 71 ILI .,:-. ZIP PHONE <br /> Jeff Larsen 1869-Madiven 3"--H-7,6- 337. M <br /> ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENS NG. <br /> GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. Z <br /> Same D-272996 c <br /> MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. 9 <br /> m <br /> PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. (�) <br /> -J <br /> PERMIT CLASS OF WORK UJ <br /> ❑COMBINATION <br /> ❑(BUILDING [PLUMBING [RMEC14ANICAL <br /> [ NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br /> VALUATION OF WORK <br /> $ 66,938.00 ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br /> DE::CRIpE WORK <br /> construct Duplex <br /> PROPOSED USE MECHANICAL <br /> two unit dwelling <br /> LEGAL DESCRIPTION OF PROPERTY(SHOW BELOW'OR ATTACH r1 1 NERDY <br /> nr <br /> ❑OAS ❑FEEL. <br /> FOUR COPIES) <br /> 36A Fairview Hei hts NO. TYPES- EQUIPMENT FEE <br /> LOT_— BLOCK—OF g I�nul cUNO.UNITS-N.P.EA. S 1 <br /> — — f I1L1HIGERATION UNITS-H.P.EA. <br /> BOILERS-H.P. EA. I <br /> L/M 6-28-5 FORCED AIR SYSTEMS-B.T.U. MEA. <br /> JOB ADDRESS SPACE a WALL HEATERS - B.T.U. <br /> 630 A 6 B Goth STREET S.E. _ UNIT HEATERS-A.T.U. I <br /> EVAPORATIVE COOLERS <br /> PLUMBING _ CLOTHES DRYERS 1on <br /> VENTILATION FAN <br /> 2 RANGE HOOD IFin <br /> rG NO. TYPE OF FIXTURE OR ITEM FEE AIR HANDLING UNIT- C.F.M. <br /> BATH TUBS 41 OnI <br /> CLOTHES WASHER 41 00 WATER HEATER <br /> { DISH WASHERS 1On FAC. BUILT FIREPLACE a CHIMNEY I <br /> i DRINKING FOUNTAINS GAS, SYSTEM: NO OP OUTLETS i— <br /> FLOOR DRAINS SUBTOTAL $ I <br /> { KITCHEN SINKS` &&DISC— _ nnOn <br /> BAR SINKS PERMIT S <br /> I ROOF DRAINS -- RAIN LEADERS TOTAL FEE S 2 100 <br /> SHOWER BATHS - THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br /> If SERVICE SINKS TION AUTHORIZED IS NOT COMMENCED WITHIN 12n DAYS, OR IF <br /> SUMPS -SEWAGE PUMP CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br /> PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br /> URINALS I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br /> WATER CLOSETS PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> WATER HEATERS - ELECTRIC _ 1 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> WASH BASINS g 1 OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> LAUNDRY TRAYS OR NOT, t-HE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> 1 OR THE PERFORMANCE OF CONSTRUCTION. <br /> SUB TOTAL <br /> PERMIT S - - 10/30/78 <br /> 1 TOTAL FEE $ Jill�4:'C_ <br /> WATER SERVICE SIZE BLDG. SUPPLY SIZE SIGNA TU RE OF CONT RAC7 0 R 0 R AUTH.AGENT DATE <br /> SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> S' 201 201 FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> 78/639 110.50 34259 <br /> R-2 7988 Bq. ft. YES ONO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP UNI OSF OWE LLING 1 <br /> V-N R-1 2 <br /> SIZE OF BLDG. NO.OF S70RIES MAX.OCC. LOAD BUILDING s 66,938.00 211 100 <br /> 241x601 2 _ PLUMBING 36 1 00 <br /> -IR ONE BASEMENT IR T-IR cTLT <br /> REOMECHANICAL 12 100 <br /> 3 none ❑yES YES [�NO <br /> SPECIAL CONDITIONS: OTHER 1 <br /> _ _ — 1 <br /> _ PENALTY_— SFO,HOB I.1 I <br /> - <br /> 'TOTAL- i 7.59 00 <br /> 1 <br /> �, ��• PFRMIT VALIDATION - <br /> -_� _ --- WillrK^nc p1 Y VALIDATED II1t1a�PAc171fr.#Ili Vt Ilnni , <br /> my <br /> m <br /> YOUR RE.CSK <br /> TH�UxY I•N:,ni[,ID MY �I„n,Y11,1/,n ► IA,�, .ECEIPr THANK YOU W <br />