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the Evergreen <br />CITY OF <br />evexett <br />259-8745 <br />('INSTRUCTION <br />PEPMIT <br />PERMIT NO. 17976 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAIL ADDRESS CHN :IV PHONE <br />Chicago Title 2931 Rucker Everett 98201 745-22OG <br />ARCHITECT OR DESIGNER MAR ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />Heath NW Inc. 11805 NE 116th Kirkland 98034 623-3100 HEATHN*330RJ <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY [IP PHONE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEr <br />CLASS OF WORK <br />Q NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />f 1.613.99 <br />Relocate sign on to roof and non-illum set of letters to wall. <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Office <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 <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PE;R¢ORI�IANCE O CONSTRUCTION. <br />SIGN'/bATfi <br />X T F 'RACY MORIZED AGENT, OR OWNER z <br />L� <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />J00 ADDRESS <br />3030 Hoyt � <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 />A/C — A/HNDLG UNITS — M.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY ( WASH BASIN) <br />BCILERS — B T.U./H.P. <br />SHOWER <br />GAS FIRED A.C. UNITS — B.T.U. <br />KITCHEN SINK S DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PFIEVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />_ <br />SINK (SERVICE —BAR ETC.) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />_ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />$1 <br />1 <br />SUB TOTAL 5_ <br />PERMIT <br />sl <br />I <br />PERMIT <br />TOTALFEE <br />$ <br />TOTAL FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />04/02/87 5:4 <br />PH 00DA04723 <br />— <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED YES NO <br />INVESTIGATION FEE <br />BLS. 304(e) 2 <br />.DD <br />STATE BUILDING SURCHARGE <br />J <br />STATE ENERGY SURCHARGE <br />CHECK, <br />5.00 <br />APPLICATION ACC. BY <br />S.H. <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />Elec. N.V. <br />L. Callahan <br />DRIVEWAY PERMIT <br />TOTAL <br />6 <br />00 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />Co <br />1� <br />Q) <br />l` <br />t— <br />ADDRESS FILE <br />