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the EPergreeR <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT. WA 98201 <br />r^ % 'ONSTRUCTION <br />PERMIT PERMIT NO. 07109 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS city tu• HONE <br />Ronald Hodge 2qnA 7a4-h Q+-ra,f 9 2 <br />21P 353-4467 <br />ARCHITECT OR DESIGNER MAIL ADDRESS City PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Self <br />LICENSE F <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE F <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />r LASS OF WORK <br />[KNEW []ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />VALUATION OF WORK <br />S <br />Install air tight stove <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 OFF 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 PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON TOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOURC(MIFSI <br />LOT BLxK_OF <br />JOB ADDRESS <br />2506 74th Street S.e. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />LAVATORY ASH BASIN) <br />BOILERS — H.P. SA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA <br />_ <br />KITCHEN SINKS 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 — D T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOU14TAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C F M <br />VACUUM BREAKERS <br />l <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE — BAR, ETC. <br />SUB TOTAL <br />SUB TOTAL 1 <br />PERMIT <br />S <br />PERMIT S <br />3 <br />00 <br />TOTAL FEE <br />8 <br />TOTAL <br />FEE 116 <br />0 <br />FIDE 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 />I YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BDaUING <br />1 <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />!YES I ]NO <br />MECHANICAL <br />6 <br />00 <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B C <br />EEC. 303 (a)— <br />2, BUILDING PLANE <br />TOTAL <br />6 <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 15 YOUR PERMIT <br />6 S 1 S <br />.T-- <br />YOUR RECEIPT C�' <br />THANK YOU <br />8. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />