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the Evergreen <br /> clTv of I"O NST R U CTI O N <br /> everett PERMIT PERMIT NO' 09301 <br /> CITY HALL 2598745 <br /> EVERETT.WA 98201 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL PPLUMBING <br /> OWNED MAIL AODHLS5 OILY IRP "WIL <br /> Stephen L. Miller 305 76th Place S .W. Everett 98203 353-4679 <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL fANTMCTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br /> CLASS OF WORN <br /> ❑NEW ❑ADOII.ON ❑AITERATiON ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br /> VALUATION OF WORK <br /> f <br /> DESCRIBE WORK <br /> install sprinkler system <br /> PROPOSED USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> LEGAL DESCRIPTION O MY(SHOW BELOW OR ATTACH FOUR COPIES) PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> Lor BLOCK_OF 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 O CONTRACTOR OR AUTHORIZED AGENT DATE <br /> JOB ADDRESS 5/26/81 <br /> 305 76th Place S .W. X <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) AIR LAND.UNITS—H.P.EA. <br /> BATHTUB REFRIGERATION UNITS—H.P.FA <br /> LAVATORY ASH BASIN BOILERS—H.P.FA. <br /> SHOWER GAS FIRED A.C.UNITS—TONNAGE EA <br /> KITCHEN SINK B DISP. FORCED AIR SYSTEMS—B T.U. M EA. <br /> DISHWASHER WALL HEATERS—8.T.U. M <br /> LAUNDRY TRAY UNIT HEATERS—B.T.U. M <br /> CLOThES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLUTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.hi <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLACES CHIMNEY <br /> SINK(SERVICE—BAR.ETC) <br /> 1 S rinkler system 2 00 <br /> SUBTOTAL 2 SUBTOTAL l <br /> PERMIT { PERMIT { <br /> TOTAL FEE f TOTAL FEE <br /> SLOE YARD SETBACK STREET SETBACK REAP YARD SETBACK PIAN CHECK NUMBER PIAN CHECK FSE <br /> FEE hECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE 1 <br /> OYES ONO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING { <br /> SIZE OF BLDG. NO,OF STORIES MAX.DCC.LOAD S 00 <br /> PLUMBING <br /> FIRE ZONE BASEMENT FIRE SPRINKLERS MECHANICAL <br /> REOUIRED <br /> OYES I)NO <br /> APPROVALS BY DATE OTHER <br /> 1. ENVIRONMENTAL CHECK LIST PENALTY U.B.C. <br /> SEC.30.3(s) <br /> 2. BUILDING PLANS 5 00 <br /> TOTAL <br /> 3, FIRE HYDRANT <br /> 4, FIRE PROTECTION SYSTEM PERMIT VALIDATION <br /> WHEN PROPERLY VALIDATED(IN THIS SPACE)THIS ISeYOUR <br /> (n�PERMIT <br /> 5 GRADING F J �. S .! 1� J r. u u <br /> 8. DRAINAGE C3 <br /> M <br /> 7. ENVIRONMENTAL IMPACT STATEMENT __ <br />