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CITY OF <br />C/''NSTRUCTION <br />Everett <br />PERMIT <br />NO. <br />20778 <br />PERMIT <br />8 <br />❑ DEMOLITION <br />❑ COMBINATION E BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />MAIL ADORESS CITY <br />ZIP <br />PHONE <br />Colby Corner Gro. <br />2934 <br />Colby Ave Everett, WA 98201 259-5868 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE <br />Owner <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE A <br />REWIRING CONTRACTOR <br />MAIL ADDRESS CITY <br />Z-F <br />PHONE LICENSE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION R1 ALTERA110N ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />f Soo <br />DESCRIBE WORK <br />Tenant remodel <br />HEATSOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Gr,ice store <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 1'O BE TRUE AND <br />CORRECT. ALL PROVISION!; OF LAPIS AND ORDINANCES <br />GOVERNING THIS TYPO OF WORK V:I. L 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 PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR AUTHONIZE O AGE NT. OR OWNER DATE <br />x ,EQ 9/1/88 <br />LEGAL DESCRIPTION OF PROPERTY ISHow BELOW on ATTACH rouR coPlesl <br />LOT _ eLxK _ of <br />JOB ADDRESS <br />2934 Colby Ave <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AC — AIHNDLG UNITS — H P <br />BATHTUD <br />REFRIGERATION UNITS — H P EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T U /H P <br />SHOWER <br />GAS FIRED A C. UNITS — B T U <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS — B T U M LA <br />DISHWASHER <br />WALL HEATCRS — BTU. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T U. M, <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL <br />f <br />SUBTOTAL S <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />f <br />TO <br />FRONT SETBACK <br />BEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE / <br />#00029M <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />[DYES❑NG <br />FEES <br />ATION <br />FEE <br />BUILDING <br />$ <br />15 <br />OO <br />TYPE OF CONST. <br />OCCUPANCY GRJUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />CWCK $18.50 <br />SIZE OF BLVG <br />_ <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED LI YES Ej NO <br />INVESTIGATION FEE <br />Sec 304(r) <br />STATE BUILDING SURCHARGE <br />3 <br />50 <br />STATE ENERGY SURCHARGE <br />APREICAT ION ACC BY <br />M. M. <br />RANSCHECKEDRY <br />AP'R FOR ISSUANCE BY <br />T. T. <br />Onlvcwnv PERMIT <br />TOTAL <br />18 <br />50 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE( THIS IS - JUR PERMIT <br />N' <br />E` <br />0 <br />CV <br />2 <br />ADDRESS FILE <br />