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the Eberwirran• <br />CITY OF <br />everett <br />259-8745 <br />INSTRUCTION f is <br />PERMIT <br />PERMIT NO. <br />17072 <br />❑ DEMOLITION a COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP MIONE <br />Melum & Smith PO 8Ox 592 Lake Stevens NA 98258 653-2025 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 1"' PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY :e• I910NE LICENSE. <br />Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY IwONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY Z" "HONE LICENSE IF <br />CUSS OF WORK <br />al NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VAI VATFON OF WORK <br />f 43,000.00 <br />DESCRIBE WORK <br />Construct single family residence <br />NEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Single family residence <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 AUTHOR17Y TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUA OF CONTFKTOR. AUTHORIZED AGENT. OR OWNER DATE <br />X G ��o <br />LEGAL DESCRIP71UN OF PROPERTY (SHOW BELOW OR ATTACH FOUR COFFEE) <br />LOT I BLOCK --4L OF Pinehurqt F <br />.FOB ADDRESS <br />23 F <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />2 <br />WATER CLOSET (TOILET) <br />_ <br />ABC - AJHNDLG UNITS - H P <br />2 <br />BATHTUB <br />REFRIGERATION UNITS - H P EA <br />LAVATORY ( WASH BASIN) <br />BOILERS - S T U M P <br />SHOWER <br />GAS FIRED AC UNITS - -BTU <br />1 <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS - B T U M EA <br />1 <br />DISHWASHER <br />r, <br />WALL HEATERS - B T U M <br />LAUNDRY TRAY <br />UNIT HEATERS - B T U M <br />1 <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />3 <br />VENTILATION FAN <br />FLOOR DRAIN <br />A 1 <br />RANGE HEVD <br />13ACKFLOW PREVENTERS <br />1 <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC I <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EAHAUSTFAN <br />SUB TOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PE <br />TOTALFEE <br />$1 <br />4 s <br />hn <br />TOTAAL FEE <br />FRONT SETBACK <br />201 <br />REARSETBACK <br />201 <br />SIDE SETBACK <br />61 <br />PLAN CHECK NUMBER <br />86/17010 <br />F11R1001707° <br />031.85 SU <br />RECEIPT NO. <br />1.80240 <br />USEZONE <br />R-1 <br />LOTAREA <br />9000 sf a rx <br />VACANT SITE <br />❑YES Lg"° <br />FEES <br />ATION <br />FEE <br />BUILDING <br />�..90 <br />TYPE OF CONST <br />V-N <br />OCCUPANCY GRO <br />R-3 <br />NO OF DWILBHG UNITS <br />1 <br />PLUMBING <br />E SRCN $1 <br />.00 <br />SIZE OF BLDO <br />1152+484 <br />NO OF STORIES <br />1 <br />MAX OCC LOAD <br />MECHANICAL <br />26 <br />50 <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />INVESTIGATION FEE <br /><(-) $1 <br />.00 <br />— <br />—IUfj <br />STATE BUILDING SURCHARGE <br />BLDG <br />1 <br />50 <br />STATE ENEf4GV SURCHARGE <br />B SRCH i <br />,SD 15 <br />UO <br />APPLICATIONACC BY <br />Sg <br />_ <br />PLAIISCHECKEDBY <br />Sg <br />APPR FOR ISSUANCE BY <br />lc <br />- - — <br />DRIVEWAY P'.RMIT <br />1 <br />TOTAL <br />CHECK $49 <br />.20 <br />00 477 <br />0 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />f9/ j N <br />C� <br />ADDRESS FILL. <br />