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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 <br />r COPBSTRUCTION <br />PERMIT <br />❑ COMBINATION BUILDING ❑ MECHANICAL <br />PERMIT NO. 08502 <br />❑ PLUMBING <br />OWNER MAIL ADDRESS Illy lily MIONI <br />Terry R. Chism 619 61st Street 98203 353-4157 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CRY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE I <br />Same <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />_ <br />h'FNSE I <br />^LUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />1.,.e r- ❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORM <br />era <br />PROPOSED USE OF BURL9NG <br />single family residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THQ, AP. <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL. BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL 'HE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCT OR ER RMANCE OF CONSTRUCTION. <br />SMNAT NTAACT TI ) NAGf NI DATE <br />1 D/ 2 9/ 8 D <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COME51 <br />:nr BLOCK_OF <br />JOB ADDRESS <br />619 61st Street <br />PLUMBING <br />MECHANpi <br />NO. <br />TYPE OF 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 />BATHTUB <br />REFRIGERATION UNITS — M.P. EA <br />LAVATORY ASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A C. UNITS —TONNAGE EA. <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA <br />DI`IWASHER <br />WALL HEATERS —8T.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 />STOVEWood-Q_ <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE IS CHIMNEY <br />_ <br />SINK SERVICE — BAR. ETC <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT <br />f <br />PERMIT IIITOTAL <br />FEE <br />f <br />TOTAL <br />FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NJ. <br />USE ZONE <br />LOT AREA <br />VACANT S1TE <br />UYES LINO <br />FEES <br />— <br />VALUATION <br />FEE <br />TYPE OF CLNST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />f <br />SIZE OF BLDG. <br />NO, OF STORIES <br />MAX. OCC. LOAD <br />PLUMBIN- <br />FIRE ZONE <br />BASE MLNT <br />FIRESPRINKLERSMECHANICAL <br />REOtI IJNO <br />7 <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 />2. BUILDING PUNS <br />TOTAL <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />9801 $OO7.JO 01 <br />In <br />Y OUR RECEIPT o <br />i HANK YO U <br />5. GRADING <br />6. DRAINAGE <br />_ <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />v.c. <br />ADDRESS FILE 2 9 OCT 80 <br />