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the Evergreen CITY ()l CC V ST R U CTI O N <br />everett PERMIT PERMIT NO.07947 <br />CITY HALL 259.8745 <br />EVERETT, WA 9B201 ❑ COMBINATION XkBUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CRY ZIP PHDNI <br />Harvey F. Nurmi 9608 60th Street N.E. Everett 98205 334-4251 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CRY ZIP PHONI <br />GENERAL CONTRACTOR MAIL ADDRESS CTTY ZIP PHONE 'BeIK.EF <br />Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS CT' ZIP PHONE LICENSE F <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑NEW <br />{ <br />❑ADDITION ❑ALTERATION ❑REPAIR DEMOLITION ❑FENCE <br />Demolish single family residence <br />0 <br />❑SIGN ❑GARAGE <br />PROPOSED USE OF BUILDING <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 LF 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 />SIGNATURE PONTRACTOR MI AUTHORIZED AOEN DATE <br />X 7/14/80 <br />LEGAL DESCRIPTION OF PROPER" (SHOW SELOWOR ATTACH FOUR COPIESI <br />LOT —BLOCK. —OF <br />Sec. 8 Twp 28 Rge 5 <br />JOB ADDRE5e74th <br />1929 XAth Street S.E. <br />PLUMBING <br />MECIAN61. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />T E OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET)AIR <br />COND. UNITS — M.P. EA <br />BATHTUB <br />REFRIGERATION UNITS — H P EA <br />LAVATORY ASH BASIN) <br />BOILERS — H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS — TONNAGE EA. <br />_ <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 — B.T.0 M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE MOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C F M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE — BAR. ETC <br />SUBTOTAL <br />SUBTOTAL { <br />PERMIT { <br />PERMIT { <br />_ <br />TOTAL FEE { <br />TOTAL <br />FEE { <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 S1TE <br />❑YES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />{ <br />00 <br />00 <br />SIZE OF BLUG. <br />NO, OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE <br />REQUIRED <br />❑YES <br />SPRINKLERS <br />ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />;ATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U B C <br />SEC 303 HU <br />2. BUILDING PLANS <br />TOTAL <br />00 <br />00 <br />3, FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5. GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />4 7 6 6 $ O O O. O U 111" <br />- <br />6, DRAINAGE <br />7, ENVIRONMENTAL IMPACT STATEMENT <br />