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the Evergreen 00�'ST R U GT I O N <br /> CITY OF <br /> everett PERMIT PERMIT NO. 09641 <br /> CITY HALL 2598745 � <br /> EVERETT.WA 98201 E) COMBINATION BUILDING _1 MECHANICAL PLUMBING <br /> PrIOr,_ <br /> OWNER MAN AGGRESS 98203 355-7714 <br /> Leslie Mc Griff 4 76th Street S.W. EC Y ZIP PHONE <br /> ARCHITECT OR DESIGNER <br /> MAIL <br /> AODREBs <br /> MAIL ADDRESS <br /> CITY 21P PHONE LICENSE/ <br /> GENERAL CONTRACTOR <br /> .Same <br /> CITY <br /> MECHANICAL CONTRACTOR MAI)AODRE66 <br /> 21P PHONE LKENSE/ <br /> CITY ZIP R(WIE LICENSE/ <br /> PLUMBING CONTRACTOR MAIL ADDRESS <br /> CUSS OF WORK <br /> ❑NEW []ADDITION []ALTERATION ®IIEPAIR []DEMOLITION ❑FENCE ❑SIGN OGARAGE <br /> VALUATION OF WORK <br /> y 2,500.00 <br /> DESCRIBE WORK <br /> re-roof--composition <br /> PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> single family residence PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> LEGAL DESCRIPTION OF PROPERTY(SHOW BELOW OR A77ACM FOUN COPIEeI ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> LOT BLOCK_OF TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br /> HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br /> 3935-000-001-0102 PRESUME TE OR CANCEL THE PRO. <br /> VISIONS OFOANY OTHER STATETY OOR LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANC'_OF CONSTRUCTION. <br /> SIGNATMRE 0-CONI TOR OR AUTHORI AGFY�'� <br /> AII <br /> JOR Aopn(�a <br /> 4 76th Street S .W. <br /> MECHANICAL _ <br /> PLUMBING TYPE OF EOUIPMENT FEE <br /> N0.WSINK& <br /> YPE OF FIXTURE OR ITEM FEE NO. <br /> AIR COlID.UNITS-H.P.EA. <br /> ET OIL REFRIGERATION UNITS-H.P.EA <br /> BOILERS-H.P.EA <br /> Al,.BASIN GAS FIRED AC.UNITS-TONNAGE FA. <br /> NI <br /> FORCED AIR SYSTEMS-A T U. M EA. _ — <br /> K 8 D16P. WALL HEATERS-B EUM <br /> R UNIT HEATERS-8 T.U. M <br /> AY EVAPORATIVE COOLERS <br /> CLOTHES WASHER CLOTHES DRYERS <br /> WATER HEATER VENTILATION FAN <br /> URINAL RANGE HOOD <br /> DRINKING FOUNTAIN AIR HANDLING UNIT- O F M <br /> FLOOR DRAIN STOVE <br /> VACUUM BREAKERS METAL FIREPLACE 6 CHIMNEY <br /> ROOF DRAINS-RAINLFADERS <br /> SINK ERVICE-BAR,ETC.I <br /> SUBTOTAL <br /> 6UB TOTAL PERMIT $ <br /> PERMIT $ TOTAL FEE <br /> TOTAL FEE $ PLAN CHECK FEE <br /> SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK PUN CHECK NUMBER FEE RECEIPT NO <br /> LOT AREA VACANT SITE FEES VALUATION FEE <br /> USE ZONE DYES DNO <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS $2500.00 38 50 <br /> BUILDING <br /> fiRE OF BLOC) NO.OF 6TORIES MAX.OCC.LOAD <br /> PLUMBING <br /> FIRE ZONE BASEMENT FIRE SPRINKLERS MECHANICAL <br /> REOUIRED <br /> DYES ONO <br /> APPROVALS <br /> By DATE OTHER <br /> 1. ENVIRONMENTAL CHECKLIST PENALTY SEC.6EC.303(e) <br /> 2. BUILDING PIANS TOTAI 38 50 <br /> 3. FIRE HYDRANT <br /> PERMIT VALIDATION <br /> 4. FIRE PROTECTION SYSTEM WHEN PROPERLY VALIDATED(IN THIS SPACE)THIS IS YOUR PERMIT n -- <br /> f T 0 C <br /> S. GRADING <br /> S. DRAINAGE <br /> rn <br /> 7. ENVIRONMENTAL IMPACT STATCMENT <br />