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the ETrrgreen <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 <br />CONSTRUCTION <br />PERMIT <br />❑ COMBINATION ❑ BUILDING IX MECHANICAL <br />PERMIT NO. 07875 <br />PLUMBING <br />OWNER MAIL ADDRESS CITY F^ PHONE <br />Olympic Bank 4201 Rucker Ave. Everett 258-3770 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ; iP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZiP PHONE LICENSE# <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY 7" PHONE LICENSE IT <br />Evergreen State Sheet Metal, Inc. P.O. Box 1508 Everett 98206 252-3114 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY Zip PHONI. LICENSER <br />w_ ❑HEW ❑ADDITION ❑ALTERATION ❑REPAIR El DEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />E <br />WORK <br />PROPOSED USE OF BUILDING <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 GOVERNIPG THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL. THE PRO. <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF`�TRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGEN DATE <br />X 7/2/80 <br />4 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK_OF <br />JOB ADDRESS <br />4201 O%pplit Rucker Avenue <br />PLUMBING <br />MECHA 1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR CONO. 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 />LAUNDRY TRAY <br />UNIT HEATERS — B T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTA114 <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR, ETC) <br />SUBTOTAL <br />SUBTOTAL t <br />8 <br />00 <br />PERMIT <br />t <br />PERMIT t <br />OO <br />TOTAL FEE <br />! <br />TOTAL <br />FEE t <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />4 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES I ENO <br />MECHANICAL <br />11 <br />OO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U BC <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />11 <br />00 <br />3. FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />'.`.. GRADING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />(n( <br />4 2 7 4 p o I I. U O IA <br />r <br />OC <br />YOUR RECEIPT <br />;HANK Y O U <br />6. DRAINAGE <br />1. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRGT <br />APPLICATION ACC. BY <br />ED BY <br />177 <br />APPR. FOR ISSUANCE B'Y <br />WL 80 <br />ADDRESS FILE <br />