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i <br />the Eve�Kreen <br />C. TYOf <br />everett <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 <br />*'.'#"aNS'TRUCTIONR <br />PERMIT <br />❑ COMBINATION ); 1X BUILDING ❑ MECHANICAL <br />PF.RMiT NO. 12075 <br />❑ PLUMBING <br />OWNER MAIL ADDIIESS CITY ZIP PHONE <br />BILL NAGEL 222 - 73rd _Everett WA 9R?n1 353-6363 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />C & W Roofing __-_--Ln924 - 19th NE Fvrrrtt WA 9AP09 334 n939 rW _ <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP HONE LICENSE A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IT <br />❑ NEW ❑ ADDITION ❑ ALTERATION X1 REPAIR ❑ DEMOLITION ❑ F,:NCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />VALUATION OF WORK <br />S 1800.00 <br />DESCRIBE WORK <br />Reroof <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 1HIS <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 AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE FCONTRACTOR RAUTHO ED AGENT DATE <br />X 6/9/83 <br />LEGAL DESCRIPTION OF PROPERTY (SNOW BELOW OR ATTACH FOUR COPIES) <br />LOT -BLOCK <br />-OF <br />_ <br />JOB&JES_ 73rd <br />((Z[[[ <br />PLUMBING <br />MECHANIC <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H,P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.F. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — M.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK& 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 — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <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 />STOVE — WOOD <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUBTOTAL f <br />SUB TOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEE f <br />_ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ..NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$1800.00 <br />29 <br />5 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />- <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />YES NO <br />MECHANICAL <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.O.C. <br />SEC. 303 (E) <br />2. DUILOING PLANS <br />TOTAL <br />29 <br />50 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS 9 SPACE) THISSO U PERMITa— LI•] <br />/ 9 1rl <br />C] <br />N <br />YOUR R E C E 1 PT `-' <br />THANK YOU <br />5. GRADING <br />S. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PUNS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />ADDRESS FILL <br />-3im83 <br />