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the Evergreen clry or C"1 NST R U CTI O N <br />everett PERMIT PERMIT N0. o9s55 <br />CITY HALL 259-8745 EVERETT, WA 98201 ❑ COMBINATION IG�E� <br />MBUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS LIlY ZR' PHUNL <br />Robert E. Dexter 1801 72nd Place <br />ARCHITECT OR DESIGNER MAIL ADDRESS CIT.' ZIP PHONE <br />DEF mo�ley TRoofing Company <br />4661 ADDRESS <br />N.E. <br />CITY <br />Lake Stevens <br />98258 <br />PONE LICENSEE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CRY <br />ZIP <br />SM OK <br />PHONE LICENSE E <br />ER 267NW <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE E <br />❑NEW ❑ADDITION OALTERATION 00KEPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VAL ATION OF WORK <br />29.00 <br />re -roof shakes & 4ot gutter <br />PROPOSED USE OF BUILDING <br />Single family residence <br />I HEREBY CERTIFY THAT 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 />VISI.)NS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTR CTION OR THE P FORMANCE OF CONSTRUCTION. <br />SIG RE COAC101 OR AU IZED AGENT PATE <br />-A 10/1/81 <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW ORATTACH FOUR COPIES) <br />5 Monte Vista <br />LOT BLOCK_OF <br />JOB ADDRESS <br />1801 72nd Place <br />PLUMBING <br />MECHA <br />ICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR CORD. UNITS - M.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA <br />LAVATORY ASH BASIN <br />BOILERS -H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS - TONNAGE EA. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS - B T U M <br />LAUNDRY TRAY <br />UNIT HEATERS - 0 ) U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />CIOTHES DRYERS <br />URINAL _ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT - <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE IL CHIMNEY <br />SINK(SERVICE - BAR, ETC. <br />SUB TOTAL <br />SUB TOTAL i <br />PERMIT 61 <br />PERMIT f <br />TOTAL FEE 81 <br />TOTAL <br />FEE i <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CLNST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />MAX. OCC. LOAD <br />BUILDING <br />S729.00 <br />14 <br />50 <br />SIZE OF BLDG <br />NO. OF STORI" <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />IYES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U SEC. 303 IAI <br />2. BUILDING PLANS <br />3 FIRE HYDRANT <br />TOTAL <br />14 <br />50 <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />�1rn� <br />m <br />S. GRADING <br />& DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />