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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 <br />CO''STRUCTION <br />PERMIT PERMIT NO. 06581 <br />❑ COMBINATION BUILDING ❑ MECHANICAL LJ PLUMBING <br />I NIP <br />MAIL ADOMSy LIT" <br />III, <br />IHONE <br />Robert D. Sebors <br />615 75th Street N83D <br />98203 <br />351-3266 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />I E <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CRY <br />ZIP <br />PHONE <br />LICENSE# <br />Same <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE / <br />ULA55 V I' W VIIA <br />❑NEW ❑ADDITION 7Rj ALTERATION LCIREPAIR ❑DEMOLITION ❑FENCE 061GN ❑GARAGE <br />VALL ATION OF WORK <br />If 4,000.00 <br />r`nn.rovHi Wn F"n ci nnla fnmi I E•n Alml av <br />PROPOSED USE OF BUILDING <br />Two family unit <br />—' <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 />CON RUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />S ATURE FCONTPA TOR LITHOWrp)AGENT DATE <br />AEF/ EaQIBRBX e/22/ <br />LEGAL OESCRIFTION OF PROPERTY ISHOW BEL0 OR ATTACH FOUR COPIES) <br />11 Beverl Div. 2 <br />LOT SLOCI 1 OF y Home Tracts <br />JOB ADDR155 <br />• 9x5X�t"xxxg 601 75th Street S.E. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />1 <br />WATER CLOSET OILET <br />AIR COND. UNITS — H P. EA. <br />1 <br />BATHTUB <br />2 <br />00 <br />REFRIGERATION UNITS — H.P. EA <br />_ <br />LAVATORY ASH BASIN <br />2 <br />00 <br />BOILERS — H.P EA. <br />SHOWER <br />GAS FIRED AC. UNITS — TONNAGE EA. <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS — ST.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 />2 <br />00 <br />-WO <br />EVAPORATIVE COOLERS <br />1 <br />WATER HEATER <br />2 <br />1 <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />1 <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C F LI <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK ISERVICS — BAR. ETC) <br />SUB TO <br />1 22 <br />nn <br />SUB TOTAL f <br />6 <br />00 <br />_ <br />PERMIT <br />f <br />PERMIT i <br />TOTAL FEE f <br />12 <br />00 <br />TOTAL <br />FEE f <br />6 <br />00 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />R-3 <br />LOT AREA <br />VACANT SITE <br />OYES W <br />FEESVALUATION <br />FEE <br />TYPE OF CONST <br />V-14 <br />OCCUPANCY GROUP <br />R-3 <br />NO. OF DWELLING UNITE <br />2 <br />BUILDING <br />S 4,000.00 <br />28 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />1 <br />MAX. DOC. LOAD <br />PLUMBING <br />12 <br />00 <br />FIRE ZONE <br />3 <br />BASEMENT <br />yes <br />FIRE SPRINKLERSREQUIRE <br />DYES f�MiO <br />DYES L <br />MECHANICAL <br />6 <br />00 <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303(9) <br />2, BUILDING PLANE AJ <br />TOTAL <br />46 <br />00 <br />3. FIRE HYDRANT <br />4. FIRE ION SYSTEM <br />PERMIT VALIDATION <br />WARN JWPf) y 6DAA LDD,Q�IS SP' F ri IS Yor"I�. II �{ � <br />�cCFP UU '•LL1l Ua ib �U 6Y YY <br />ac <br />I <br />OUR RECEIPT 'YOUR RECSEIP <br />THANK YOU TIBANK Y O U R <br />'J 5 ORA • G r— <br />N <br />....6 DRAIAAGI,O p <br />R 1 FNVI NM TAL IM STATEMENT <br />V8 HEALT RIcT <br />APPLIC4&I BY ' <br />C <br />_ <br />PLANS CHECKED BY <br />V.C. <br />A" FOR ISSUANCE BY <br />AL 21+�19. <br />ADDRESS FILE <br />9 <br />