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� <br /> llrC��Pcr(rrCri w O� /�������/� �1 <br /> C�1Y OF �� V/ �7 �� � <br /> everett PERMIT PERMIT N0. 14645 <br /> CITY MALL 259-B7d5 <br /> eveaEi�,wnsazo� ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWNER MAIIFD�RE55 GITY '.iP PNONE <br /> Plaid Pantry 2540 N.E. Riverside Wav Portland 9BB-q��F <br /> APp11TECf OR OESIGNER MAIL AODRE55 CITY 21P FMONE <br /> � GENEflAL GONTRAGTOR MAIL ADDRE55 C�TY ZIP PHONE LICENSE M <br /> Ki kland 98003 822-1200 <br /> MAI�ADDFE55 CITY ZIP PHONE 4LENSE� <br /> MEc � A � NORTHNP25402 <br /> PLUM9ING GONTRAGTOR MAII AD�AE55 CITY 21P PHONE LICENSE N <br /> CLA55 OF WORK �� <br /> O NEW O ADDITION ❑ ALTERATION �REPAIR ❑ DEMOIIiION ❑ FENCE �SIGN O WOOD STOVFJFIREPLACE INSERT <br /> yqlOAiION OF WORK <br /> s Z �S <br /> DESCRIBE WOPK <br /> install illiuninated sign <br /> PpOPO5EDU5E OF BUIIDING I HEREBY CERTIFY THAT I HAVE READ AND EXNMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> LEGRL OESC9IPTION OF PROPERTV�SHOW BELOW OP ATiACH FOUF GOPIES) CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> LOT_BLOGN__OF WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A <br /> FERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br /> OR CANCEL 7HE PROVISIONS OF ANY OTHER STATE OR <br /> LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. <br /> JOC ADDRESS SIGN�TU E F CGN GT H OR AUTNORIZEO AGEN7 �AT� � <br /> 1602 Broaaway X � � � ' <br /> PLUMBING MECHA ICAL <br /> N0. TYCE OF FIXTURE OR ITEM FEE N0. TYPE O UIPMENT FEE _ <br /> WATEFCLC��SET�TOILETi AIR CON�.UNITS— H.P.EA. <br /> BA7MTU8 (1EFRIGERATION UNITS— M.P. EA. <br /> Lp'JATORY(WASH BASIN� BOILERS — H.P.EA. <br /> SHOWER GAS FIRED A.C.UNI7S —TOKNAGE EA. <br /> KITCHEN SINK 8 DISP. FORt:ED AIR SYSTEMS— B.T.U. M EA. <br /> DISMWP.SMER WALL HEATEflS— B.T.�. M <br /> IAUNDRY TRAY UNIT HEAfERS— B.T.U. M I <br /> CLOTHES WASHER EVAPORATNE COOLEFS_ <br /> WATLF HEATEF CLOTHES DRVERS _ I <br /> URINAL VENTILATION FAN - i <br /> ORINKING FOUNTAIN RANGE MOOD <br /> FLOOR ORAIN AIR HANDLING VNIT-- GF.M. __ , <br /> VACUU�d BREAKERS STOVE —WOOD ___ <br /> ROOF DRAINS— RAINLEADERS METAL FIREPi.ACE 8 CHIMNEY � <br /> I <br /> SINK�SERVICE — BAR, ETC.) FIREPLACE'NSERT _ ' <br /> HEAT PUNP I <br /> SUB TOTAL S SUBTOTAL s <br /> PEflN.1T S PERMIT s _ <br /> 70TAL FEE S TO7AL FEE 1 �i <br /> SIDE VARD SETBACK STREET SETBACN REAR YARD SETBACK PLAN GHECK NUM�EH PLAN CHECK FEE . <br /> FEE RECEIPT NO. <br /> USE ZONE lOT AREA VAGAN7 SI7E FEES VALUATION FEE <br /> . .YES i �.NO <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELUNG UNITS <br /> eUILDING SZ10Q00 12 00 <br /> SIZE OF OLDG. NO.OF STOHIES MAX.OCQ LOA� J <br /> PLUMBING <br /> FIHL ZONE BASEMENT FIPE SPRINKLERS MECHANICAL <br /> REOUIRED <br /> YES NO <br /> .�� OTHER <br /> APPROVAlS BY Of.*c � <br /> � 1. ENVIqONMENTAL CHECK LIST PENALTY U.B.C. <br /> SEC.903(al <br /> p,pIJILGING PLANS ZZ BO <br /> TOTAL <br /> 3.RFEMVORANT ' <br /> 4.FIFE PHO7EC7ION SYSTEM PEflMIT VpLIDATION <br /> WHEN PROPERLY VALIDATEO�IN THIS.SPACE)TMIS�S YI IJJR PERMIT �n <br /> 5.CaRADING � � - `'Y. ' <br /> 6.DRAINAGE �D � <br /> � LENVIRONMENTALIMPACTSTATEMENT 'V� <br /> 8.HFALTH GSTRICT j� � � <br /> APPLICATIGN ACC.8Y PLANS CHECKED BY APPR.FOR ISSUANCE BY <br /> ADDR[S� 19LE <br /> (.� - <br /> J <br />