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the Evergreen <br />"O N ST R U CT I O N <br />CITY OF <br />everett <br />PERMIT <br />PERMIT NO.1.0056 <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 <br />❑ COMBINATION ❑BUILDING ❑MECHANICAL <br />PLUMBING <br />OWNER <br />MAIL ADDRES} GRY <br />ZIP <br />PHONE <br />William D. Tackitt <br />9506 19th Avenue S.E. Everett <br />98204 <br />337-1234 <br />ARCHITECT OR DESIGNER <br />MAILADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTPACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE IF <br />Same <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE IF <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE) <br />❑NEW ❑ADDITION RkLTERATION ❑REPAIR ❑DEMOLITION ❑FL ACE ❑SIGN ❑GARAGE: <br />VALUATION OF WORK <br />$ 5,000.00 <br />DESCRIBE WORK <br />tenant improvement <br />PROPOSED USE OP DUILDING <br />mini market <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TQGIVE AUTHORITI' VIOLATE OR CANCEL THE PRO- <br />VISIONS /F,,AOTHER STE RLOCAL LAW REGULATING <br />CONST ORTHEP FO ANCE OF CONSTRUCTION. <br />SIGNAIUt _ OF10R UT OR GENT / DATE <br />X — <br />LEGAL DLSCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK —OF _ <br />18-28N-5 <br />JOB ADDRESS <br />9506 19th Avenue S.E. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS— H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS — B T.U. M EA. <br />DISHWASHER <br />WALL HEATERS--B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />WATER HE <br />URINAL <br />DRINKING <br />1 FLOOR DRAIN Z U U AIR HANOUNG UNIT — c.H M. <br />VACUUM BREAKERS STDVE <br />ROOF DRAINS— RAINLFADERS METAL FIREPLACE 8 CHIMNEY <br />T CINV ICPRVICF — PAR FTC) 2 00 1 1_- <br />PERMIT S r.P.I. _ <br />TOTAL FEE S TOTAL PEE 5 <br />SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />81/10056 FEE. 32 83 RECEIPT NO. <br />USE ZONE LOT AREA VACANT SITE (' <br />OYES LINO FEES VAL 100N FEE <br />TYPE OF CONST. OCCUPANCY GROUP NO, OF DWELLING UNITS <br />V-1 Hr. B-2 <br />BUILDING $ <br />5 T 000. SO 00 <br />SIZE OF BLDG. NO. OF STORIES MAX. OGG. LOAD <br />.35 S. Ft. add 1 PLUMBING 6 00 <br />FIRE ZONE BASEMENT FIRE SPRINKLERS <br />REQUIRED MECOANICAL <br />OYES XUD <br />APPROVALS BY DATE OTHER <br />1. ENVIRONMENTAL CHECK LIST PENALTY U.BC. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT TOTAL 56 00 <br />4. FIRE PROTECTION SYSTEM PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5. GRADING Qq <br />6, DRAINAGE— LC? <br />7. ENVIRONMENTAL IMPACT STATEMENT c::) <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY !APPAL91SSUANCEBY <br />HWM <br />I <br />ADDRESS FILE 1 1 <br />i <br />