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GI <br />I l;. I I, , '11 <br />everett <br />CITY HALL 2594745 <br />EVERETT. WA 98201 <br />"ONSTRUCTION <br />PERMIT <br />0 COMBINATION J1 BUILDING X MECHANICAL <br />PERMI NO. 12666 <br />X PLUMBING <br />OWNER MAIL ADDRESS <br />Ken Berg 17928 43rd Avenue N.E. Arlington 98223 659-6847 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />AIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE' <br />GENERAL CONTRACTOR <br />Same <br />YMEC187RC <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE' <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE' <br />11.a or .mn <br />$KNEW ❑ADDITION ❑ ALTERATI011 ❑REPAIR ❑DEMOLITION ❑FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />VALUATION OF WORK <br />L 50,000.00 <br />PP, POSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Single Family Residence <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />LEGAL DESCRIPTION Of PROPERTY (SHOW BELOW OR ATTACH FOUR CORESI <br />41 Valley View <br />9II <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />LOT_BLOCK_OF <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />U 8 28 5 <br />PERFO .ONCE OF CONSTRUCTION. <br />510 AT I F CONIRACTOR NORIZED AGENT DATE <br />_ <br />JOB ADDRESS <br />2421 81st Place S.E. <br />K - <br />PLUMBING <br />MEC ANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />2 <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS - M.P. EA. <br />2 <br />PATHTUS <br />4 <br />00 <br />REFRIGERATION UNITS - H.P. EA. <br />2 <br />LAVATORY (WASH BASIN) <br />4 <br />oo <br />BOILERS -H.P. EA, <br />SHOWER <br />GAS FIRED A . UNITS - TONNAGE EA. <br />l <br />KITCHEN SINK S DISP. <br />2 <br />00 <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />1 <br />DISHWASHER <br />2 <br />OO <br />WALL HEATERS - B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS - B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />1 <br />CLOTHES DRYERS <br />4 <br />SO <br />URINAL <br />l <br />VENTILATION FAN <br />O <br />DRINKING FOUNTAIN <br />1 <br />RANGE HOOD <br />4 <br />SIX. - <br />FLOOR DRAIN <br />AIR HANDLING UNIT - C.F.M. <br />VACUUM BREAKERS <br />STOVE - WOOD <br />ROOF DRAINS - RAINLEAOERS <br />METAL FIREPLACE S CHIMNEY <br />SINK ISERVICE - BAR, ETC.) <br />FIREPLACE INSERT <br />- <br />HEAT PUMP <br />SUBTOTAL <br />f <br />SUB TOTAL S <br />12 <br />00 <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />111 <br />20 <br />100 <br />TOTAL FEE 11 <br />12 <br />00 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />0 (E)-101(W) <br />201 <br />201 <br />83/12666 <br />rEE 183.95 <br />RECEIPT NO. <br />65536 <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />R-1 <br />RYES NO <br />TYPE OF CONST. <br />UP NCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$50,000. <br />283 <br />00 <br />V-N <br />R-3 <br />1 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />20 <br />00 <br />louse 1�390 Sq. Ft. <br />1 <br />5 <br />PLUMBING <br />1'FTREZONE Sq. <br />BASEMENT <br />FIRE fiPRINKLERS <br />MECHANICAL <br />12 <br />00 <br />REOUIRE�Dp� <br />OTHER <br />None <br />:.YES 1pN0 <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHEQN LIST <br />PENALTY <br />U.B C. <br />SEC. 9071BI <br />2. BUILDING PLANS <br />TOTAL T <br />315 <br />00 <br />7, FIRE HYDRANT <br />_ <br />A. FIRE PROTECTION SYSTEM <br />PERMIWHEN PROPERLY <br />WHEN PROPERLY VALIDATED RN TH P THI Y P R IT <br />S.ORADING <br />T 77 (\ <br />III 1•" ;iIR RECEIPTr- <br />- -C O 1= J <br />1ANK YOU <br />.6. DRAINAGE "" <br />ENVIRONME AL IMP C 6TATEMENT <br />.HEALTNOI CT q <br />Ig1PPLICA/TI'B�N PLANS CHECKED BY <br />APPR. FOR ISSUANCE B <br />yBl, HWN <br />tc <br />n, <br />[Al <br />ADDRESS FILE <br />b, -(TDEC 8S <br />