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L <br />the Evergreen "O N ST R U CT I O N <br />CITY OF <br />everett PERMIT PERMIT NO.09040 <br />CITY HALL 259 0745 <br />EVERETT. WA 98201 COMBINATION "BUILDING (XIXMECHANICAL_PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Robert N. Brokaw 501 Colby 98201 259-4077 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICCNSE P <br />Summitt Western Inc. 501 Colby Everett 98201 259-4077 <br />MECHANICAL CONTRACTOR MAIL ADDRESS Cl" ZIP PHONE LICENSE <br />SU NN TIN *1O1Q6 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />CLASS OF WORK <br />J NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORT <br />L 120,000.00 <br />Construct Duplex <br />PROPOSED USE OF BUILDING <br />lex <br />LoT---2_BLOCK_ioF Beverly Hills Di <br />R 6 28 5 <br />G3rTADO...1529 63rd Street S.E. <br />I HEREBY CERTIFY I HAT I HAVE READ AND EXAMINED THIS 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 THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION, <br />SIONATyy��E OF CONi CfORO UTNORIZE DENT DALE <br />x �l � 771 R 3/?/ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ROIL <br />AIR COND UNITS — I I.P. EA <br />2 <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />4 <br />LAVATORY ASH BASIN <br />8 <br />00 <br />BOILERS — H P FA, <br />SHOWER <br />GAS FIRED A C. UNITS - TONNAGE EA. <br />2 <br />KITCHEN SINK 6 DISP. <br />00 <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />2 <br />DISHWASHER <br />4 <br />00. <br />WALL HEATERS - B T U. M <br />' <br />LAUNDRY TRAY <br />I <br />UNIT HEATERS - B T U M <br />CLOTHES WASHER <br />A <br />AnI <br />EVAPORATIVE COOLERS <br />2 <br />WATER HEATER <br />4 <br />nni <br />2 <br />CLOTHES DRYERS <br />URINAL <br />1 4 <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />2 <br />RANGE HOOD <br />Am <br />FLOOR DRAIN <br />AIR HANDLING UNIT - C.F.M. <br />_ <br />VACUUM BREAPFF6 <br />STOVE <br />ROOF DRAINS - HAINLEAOERS <br />2 <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERViE - BAR, ETC.) <br />SUB TOTAL <br />SUB TOTAL f <br />39 <br />00 <br />PERMIT f <br />PERMIT f <br />_ <br />_ _ <br />TOTAL FEE f <br />36 <br />TOTAL <br />FEE 8 <br />39 <br />00 <br />SIDE YARD SETBACK <br />51 <br />STREET SLT BACK <br />201 <br />REAR YARD SETBACK <br />201 <br />PLAN CHECK NUMBER <br />81�9040 <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO <br />USE ZONE <br />R-2)PRD Pern <br />LOT AREA <br />it <br />VACAW SITE <br />kIXES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />VTN <br />OCCUPANCY GROUP <br />R-3 <br />NO. OF DWELLING UNITS <br />2 <br />BUILDING <br />S 120,000. <br />5 33 <br />00 <br />SIZE OF BLDG. <br />NO, OF STORIES <br />I <br />MAX. OOC. LOAD <br />PLUMBING <br />36 <br />00 <br />FIRE ZONE <br />BASEMENT <br />FIRE <br />RED <br />❑YESXWNO <br />6PRINKLERS <br />UIpp,,���� <br />MECHANICAL <br />39 <br />00 <br />APPROVALS <br />BY <br />DAT. <br />OTHER <br />I. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U B.C. <br />SEC. 3031e) <br />2. BUILD140 PLANS " <br />TOTAL <br />608 <br />00 <br />3, FIRE HYDRANT - <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />I J <br />PERMIT VALIDATION � <br />WHEN FROPERLYVAETDATED RN THIS S ACE) THIS IS YOUR PERMIT <br />� <br />I'I'I G <br />I <br />, <br />I J <br />..I <br />8. DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATFMENT <br />B. HE LTH DISTRICT <br />APPLICATION AOC. BY <br />. <br />PLANS CHECKED BY <br />IV.C. <br />APPR FOR ISSUANCE BY <br />.V <br />J <br />ADDRESS FILE <br />71 <br />