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the Evergreen <br />CITY OF <br />everett <br />CITY MALL 259 8745 <br />EVERETT. WA 98201 <br />':ONSTRUCTIOV <br />PERMIT <br />U COMBINATION X BUILDING X MECHANICAL <br />PERMIT NO. 145 2', <br />K PLUMBING <br />OWNER .. , <br />ZIP PHONE <br />Pioneer Bank <br />Lynnwood <br />ARCHITECT OR DESIGNER MAIL ADURLSS CIII' ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE F <br />Ken Berg <br />17928 43rd Avenue N.E. <br />Arlington <br />98Z23— 659-6847 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />:ITN <br />ZIP PHONE LICENSC I <br />KENBEC187RC <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE F <br />CLASS OF WORK <br />❑ NEW <br />❑ ADnIT10N ❑ ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ FENCE <br />❑ SIGN ❑ WOOD STOVFJFIREPLACE INSERT <br />VALUATION OF WORK <br />f 21.000.00 <br />Construct Single Family Residence <br />PROPOSED USE OF BUILDING <br />Single Family Residence <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <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 />PE MANCE OF CONSTRUCTION. <br />SIGNATU OF CONT OR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPT'ON OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />19 Valley View <br />LOT _ BLOCK —OF <br />JOB ADDRESS <br />2518 Blst Placn G.E. <br />PLUMBING <br />ME H NICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMEW <br />FEE <br />WATER CLOSET ITOILET) <br />4 <br />AIR COND, UNITS - H.P. EA. <br />�— <br />BATHTUB <br />2 <br />REFRIGERATION UNITS - M.P. EA. <br />LAVATORI(WASH BASIN) <br />4 <br />00 <br />BOILERS - RR EA. <br />SHOWER <br />2 <br />00 <br />OAS FIRED A.C. UNITS - TONNAGE EA, <br />KITCHEN SINK A DISP <br />2 <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />2 <br />00 <br />WALL HEATERS - B.T.U. M <br />1 <br />LAUNDRYTRAY <br />2 <br />00 <br />UNIT HEATERS - 6.T.0 M <br />1 <br />CLOTHES WASHER <br />2 <br />00 <br />EVAPORATIVE COOLERS <br />1 <br />WATER HEATER <br />2 <br />00 <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE f ,OD <br />4 <br />Sn_ <br />FLOOR DRAIN <br />AIR H .,.DLINO UNIT - C.F.M. <br />VACUUM BREAKERS <br />STOVE - WOOD <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE - BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUBTOTAL f <br />22 <br />00 <br />SUB TOTAL t <br />15 <br />00 <br />_ <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />22 <br />00 <br />TOTAL FEE f <br />15 <br />00 <br />BIDE YARD SETBACK <br />STREET SEI BACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO, <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />..YES '. NO <br />FEES <br />VALUA'ION <br />- <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />f <br />146 <br />50 <br />SIZEOF SLOG, <br />NO. OF STORIES <br />MAX, OCC. LOAD <br />PLUMBING <br />22 <br />00 <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />..YES NO <br />C MECHANIAL <br />15 100 <br />OTHER <br />-- <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />LIB.C. <br />303(A) <br />2. BUILDING PLANSSEC. <br />- <br />TOTAL <br />183 <br />50 <br />3.FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION I ; <br />WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR FEAMIT -IM 1 <br />00 <br />5. GRADING <br />B. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8, HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CnECKED BY <br />APPR. FOR 169UANCE BY <br />O <br />m <br />ADDRI. ') I lLl- <br />