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NIA T I, I „rI <br />everett <br />CITY HALL 2598745 <br />EVERETT, WA 98201 <br />';,r)N.STRUCTIOW <br />PERMIT PERMIT NO. 12564 <br />❑ COMBINATION 0 BUILDING 19KMECHANICAL 1 PLUMBING <br />OWNER <br />MAIL ADORESS <br />CITY <br />'' <br />PHONE <br />Kurt Bropvik <br />8903 7th Avenue S.E. <br />E�rerett <br />911204 <br />355-5202 <br />A9CHITECT OR DE! IGNER <br />AIAII ADDRESS <br />CT' <br />!Ip <br />PHONE <br />Gin <br />fin <br />PHONE LICENSE F <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />Same <br />MECHANICAL CONTRACTOR <br />HAIL ADDRESS <br />CITY <br />_ <br />11P <br />PHONE LICENSE F <br />PLUMBING CONTRACTOR MAIL ADDRESS CRY ZIP PHONE LICENSE-0 <br />❑ NEW ❑ ADDITION ❑ At <br />VALUATION OF WORK <br />f <br />DESCRIBE WORK <br />ITION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN R WOOD STOVEIFIREPLACE INSERT <br />llltl {.Q11 NVVU vYauu.y iv <br />PROPOSED USE OF BUILDING <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 />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW 01 ATTACH FOUR COPIES, <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />LOT —BLOCK _OF <br />WHETHER SPECIFIED HEREIN OR NCT. 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 />PERFORMANCE OF CONSTRUCTION. <br />SIG NAtU E OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />JOB ADDRESS <br />X 10 18 83 <br />8903 7th Avenue S.E. �� <br />PLUMPING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS - H.P. EA. <br />BATHTUB <br />REFRIpERA710N UNITS - H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS - H.P. EA. <br />GAS FIRED A.C. UNITS - TONNAGE EA. <br />SHOWER <br />KITCHEN SINK L DISP. <br />FORCED AIR SYSTEMS -- B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS - B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS - IS M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT - C.F.M. <br />VACUUM BREAKERS <br />1 <br />STOVE - WOOD <br />7 <br />50 <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE - BAR, ETC.) <br />FIREPLACE INSERT <br />_ <br />HEAT PUMP <br />SUB TOTAL <br />3 <br />SUB TOTAL f <br />7 <br />50 <br />PERMIT f <br />PERMIT 3 <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />17 <br />50 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN ZHECK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />YES NO <br />TYPE OF CONST. <br />CCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />f <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE BASEMENT <br />KLERS <br />q <br />M:CHANICAL <br />1-1 <br />50 <br />OUIHED <br />- <br />YES NO <br />APPROVALS <br />BY DATE <br />OTHER —_ <br />U MG. <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />SEC. 303 (A) <br />2. BUILDING PLANS <br />TOTAL <br />17 <br />50 <br />3. FIRE HYDRANT <br />A. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATK IN <br />) THISQO•Z1 qI fygIT�� <br />WHEN PROPERLY VALIDATED (IN TI'.IF BP f f•duS <br />_ T <br />5. GRADING <br />CL <br />U`, <br />yo0R RECEIPT._ <br />S. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />THANK YOU <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />O7 <br />8 wt 0i <br />C <br />—1 <br />r <br />m <br />ADDRESS FILE <br />