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the Evergreen ^0 N ST R U CTI O N <br /> crtY ns <br /> everett PERMIT PERMIT NO. 10093 <br /> CITY HALL 259.8745 <br /> EVERETT.WA 98201 ❑ COMBINATION ❑ BUILDING �>MECHANICAL PLUMBING <br /> OWNER <br /> MAIL AUURfSS :" IYIVNE <br /> Thang Xuandao 107 79th Place S .E. Everett 98203 347-1453 <br /> ARCHITECT OF DESIGNER MAIL ADDRESS cnY LII• RHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY III' PHONE LICENSEE <br /> Same <br /> MECHANICAL CONTRACTOR MAIL AODRE56 CITY ZIP RM]NE LIENSEF <br /> PLUMBING CONTRACTOR MAIL AODRE56 CITY ZIP PHONE LICENSEE <br /> CLASS OF WOPK <br /> ❑NEW I7ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑BION 0GARAGE <br /> VALUATION OF WORN <br /> 1 <br /> DESCRIBE WORK <br /> install wood stove <br /> PROPOSED USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br /> LERAL DESCRIPTION OF PROPERrr ISIHow BELow oR ATTACII FOUR COPIESI PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> LOT BLOCK—OF TYPE FIED <br /> HEREIN F OR RK I LL E NOT. THEGRANTING OF A PERMIT COMPLIED WITH RDOES I 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 OP CONTRACTOR OR AUTHORIZED AGENT DATE <br /> JOB ADDRESS X <br /> 107 79th Place S.E. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET iTOILEn AIR COND UNITS—H P.EA <br /> BATHTUB REFRIGERATION UNITS—H P.EA <br /> _ LAVATORY ASH BASIN) BOILERS—H.EA. <br /> SHOWER GAS FIRED Ac UNITS—TONNAGE FA. <br /> KITCHEN SINK 6 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER WALL HEATERS—B T.U. M <br /> LAUNDRY TRAY UNIT HEATERS—8T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C F M <br /> VACUUM BREAKERS 1 STOVE Wood 7 50 <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLACE 6 CHIMNEY <br /> SINK(SERVICE—BAR.ETC. <br /> SUBTOTAL SUBTOTAL <br /> PERMIT 1 PERMIT 1 <br /> TOTAL FEE 0 17 1 50 <br /> TOTAL FEE <br /> SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK PIAN CHECK NUMBER PLAN CHECK FEE <br /> EEE RECEIPT NO <br /> USE ZONE LOT AREA V�NT ONO ITE FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING 1 <br /> SIZE OF BLDG. NO OF STORKS MAX.DCC.LOAD <br /> PLUMBING <br /> FIRE ZONE PASEMEN7 REOU RED KLERS MECHANICAL 17 50 <br /> AYES LINO <br /> APPROVALS BY DATE OTHER <br /> t ENVIRONMENTAL CHECK LIST PENALTY U.BC <br /> SEC.30310 _ <br /> 2. BUILDING PLANS TOTAL 17 50 <br /> 3. FIRE HYDRANT <br /> 4. FIRE PROTECTION SYSTEM PERMIT VALIDATION <br /> WHEN PROPERLY VALIDATED LIN THIS SPACE)THIS IS YOURI PERMIT <br /> 5. GRADING <br /> 8. DRAINAGE <br /> 7, ENVIRONMENTAL IMPACT STATEMENT <br /> 8. HEALTH DISTRICT I T� <br /> APPLICATION ACC.BV PlAN6 CHECKED BY APPR FOR I65UANCE BY <br /> ADDRESS FILE <br />