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the Evergreen <br />CITY or <br />CONSTRUCTIC�I � <br />everett <br />PERMIT <br />PERMIT NO. <br />13301 <br />CITY HALL 2598745 <br />EVERETT. WA 96201 <br />®( COMBINATION BUILDING ❑ MECHANICAL <br />PLUMBING <br />OWNER <br />MAiL ADDRESS <br />511 - 86th SE Everett WA 355-3809 <br />PHONE <br />Larry Watts <br />CITY <br />ZIP <br />PHONE <br />APCHITECT OR E ION R <br />' MAIL ADDRESS <br />MAIL ADDRESS CITY <br />ZIP <br />PRONE LICENSE F <br />EN AL CONTRACTOR <br />EVERETT RIDRS <br />5606 Evergreen WayEverett 98203 <br />353-7161 <br />LICENSE) <br />..... ._. _,.... CITY <br />ZIP <br />PHONE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION 0 ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE [I SIGN ❑ W000 STOVE/FIREPLACE INSET <br />VALUATION OF WORK <br />14975.00 <br />DESCRIBE WORK <br />Finish family room <br />PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Single family residence APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />LT1i 15 BLocK__OF Wellington Manor GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER ED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT IPR SUMETO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL OF ANY OTHERLOCAL LAW H EGULLATINGSCONSTR CONSTRUCTION OR <br />THE <br />PERFORMANCE OF COMSTRUCTION. <br />...,. SM, rnumACTONOdAUTHORIZED AGENT DATE <br />511 - 86th SE ^ <br />PLUMBING MECHANICAL <br />N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) AIR COND. UNITS - H.P. EA. <br />REFRIGERATION UNITS - H.P. EA. <br />BATHTUB <br />LAVATORY (WASH BASIN) BOILERS - H.P. EA. <br />OAS FIRED A.C. UNITS -TONNAGE EA. <br />SHOWER <br />-B.T.U. M EA. <br />KITCHEN SINKS DISP. FORCED AIR SYSTEMS <br />WALL HEATERS -B.T.U. M <br />DISHWASHER <br />UNIT HEATERS -B.T.U. _ M <br />CLOTHES DRYERS <br />—• <br />WATER=DRAIN <br />VENTILATION FAN <br />URINAL <br />RANGE H000 <br />DRINKI <br />AIR HANDLING UNIT - C.F.M. <br />FLOORVACUU <br />STOVE FI WPLA <br />METAL FIREPLACE S CHIMNEY <br />ROOF <br />FIREPLACE INSERT <br />R.TC) <br />SINK (SERVICE - BAR, ETC.) <br />BUO TOTAL <br />t <br />SUB TOTAL <br />t <br />PERMIT <br />5 <br />PERMIT <br />$ <br />TOTALFEE <br />_ <br />TOTAL FEE <br />f <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />RECEIPT NO. <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SEI BACK <br />FEES <br />FEE <br />VALUATION <br />FEE <br />i <br />f <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />YES . NO <br />H <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />PLUMBING <br />= 4975.00 <br />6 <br />f <br />SIZE OF SLUG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />_ <br />FIRE ZONE BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />'01 �. <br />YES NO <br />ATE <br />BY DATE <br />OTHER <br />- U.B.C. <br />PENALTY SEC. 303 (a) - <br />TOTAL <br />PERMIt <br />WHEN PROPERLY VALIDATED (IN THIS SPACE THIS <br />WHEN PROPEVALIDARLY —� <br />E <br />E. <br />C <br />I. ENVIRONMENTAL CHECK LIST <br />2.BUILDING PLAN <br />3, FIRh HYDRANT _ <br />4. FIRE PROTECTION SYBTkNk <br />I[ <br />S. GRAOIHG <br />M <br />r MDRAINAGE <br />M <br />—77 ENVIRONMENT LIMPAQTjTATEMENT <br />P. I PTr-+ <br />r HEALTH DISTRICT c� <br />PLICATION AC . BY LANB CNECKED BY <br />APPR, FOR ISSUANCE BY <br />, t <br />V <br />cn �) O <br />7 <br />7 Ida 84 <br />(�,) <br />ADDRE55 FILE <br />