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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259.8745 <br />EVERETT. WA 98201 <br />'~ C''INSTRUCTION <br />PERMIT <br />❑ COMBINATION INI RUILDING MECHANICAL <br />PERMIT NO. 07229 <br />PLUMBING <br />OWNER MAIL ADIMLSS <br />UIY IYIWIf <br />Bassen 2119 74th 98203 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY LP rHONE <br />GENERAL CONTRACTOR <br />Damage Repair Service <br />MAIL ADDRESS <br />CITY ZIP <br />98203 <br />PHONE <br />LICENSE 1 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE F <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />❑NEW ❑ADDITION ❑ALTERATION 5ftEPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />S 1,000.00 <br />DESCRIBE WORK <br />Repair water damage to ceiling <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 />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERF MANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHOR12 D AG NT 2�DATE <br />X Vy <br />LEGAL DESCRIPTION OF PROPERTYISHOW BELOW OR ATTACH FOUR COPIES, <br />LOT RLOCI <br />JOB�DORF55,'4tF1 Street <br />ll��``JJ <br />PLUMBIIlO <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />I FEE <br />WATER CLOSET OIL <br />AIR COND, UNITS — H.P. EA, <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />LAVATORY ASH BASIN <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A C. UNITS —TONNAGE EA. <br />KITCHEN SINK 6 DISP, <br />FORCED AIR SYSTEMS — 8 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 />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 <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE — BAR. ETC. <br />SUB TOTAL <br />SUB TOTAL { <br />PEP.MIT { <br />PERMIT { <br />TOTALFEE <br />TOTAL <br />FEE 61 <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 LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CLNST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$1,000.00 <br />10 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX, OCG. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE <br />REQUIRED <br />LIVES <br />SPRINKLERS <br />FINE) <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />PENALTY <br />U.BC. <br />SEC. 303 (a) <br />00 <br />3. FIRE HYDRANT <br />TOTAL <br />10 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />Cif <br />822 3 `N <br />� O I O.O O —'� l � <br />111��� <br />CD <br />YOUR RECEIPT <br />7uAAly ., <br />5. GRADING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION AOC. BY <br />PLANS CHECKED BY <br />APPH FOR ISSUANCE BY <br />..11.111 I VU <br />ADDRESS FILE <br />