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The Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT. WA 88201 <br />CONSTRUCTION <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />everett <br />,.e <br />OWNER MAIL ADDRESS /II• PHONF <br />King McCauley Homes 7024 Evergreen Way 353-8600 <br />M <br />M <br />ARC141TECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />K <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Same <br />Z <br />C <br />MECHANICALCONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />9 <br />W <br />Q) m <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />❑COMBINATION <br />❑BUILDING []PLUMBING []MECHANICAL <br />CLASS OF WORK <br />❑NEW []ADDITION ❑ALTERAl10N ❑REPAIR <br />VALUATION OF WORK <br />S <br />Py <br />L9DEMOLISH ❑FENCE ❑SIGN []SWIMMING POOL <br />DESCRIBE WORK <br />Demolish Sing)e Family Residence <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY <br />❑DAB ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY( OW BE W R T CH <br />FOMSOP1ES) taurei f�e ig�i�s <br />PP .i-W Ptn 4 <br />LOT BLOCK OF _ <br />-� <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S 1 <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA, <br />1 <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />JOR ADDRESS • /,' <br />Q � ��� <br />SPACE A WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.U. <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGE HOOD <br />1 <br />NO. <br />_ <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />CLOTHES WASHER <br />_� <br />WATER HEATER <br />DISH WASHERS <br />I <br />PAC. BUILT FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />I <br />FLOOR DRAINS <br />I <br />GAS, SYSTEM: NO OP OUTLETS <br />KITCHEN SINKS 8 DISP. <br />I <br />SUBTOTAL S <br />1 <br />BAR SINKS <br />1 <br />PERMIT S <br />ROOF DRAINS - RAIN LEADERS <br />I <br />TOTAL FEE S <br />1 <br />SHOWER BATHS <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO RE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />x 5/31/79 <br />�� r <br />SIGNATURE OF CON TRACTOR OR TH. AG T DATE <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />WATER CLOSETS <br />1 <br />_ <br />WATER HEATERS - ELECTRIC <br />I <br />_ <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />I <br />I <br />SUB TOTAL <br />PERMIT <br />$ <br />TOTAL FEE <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE__ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />P N CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITS <br />NO.OF DWELLING <br />I <br />BUILDING <br />$ <br />OO 1 OO <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX.00C. LOAD <br />PLUMBING <br />I <br />I <br />FIRE ZONE <br />BASEMENT FIRE <br />REQUIRED <br />SPIT I NKLERS <br />OYES []NO <br />MECHANICAL <br />I <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />1 <br />PENALTY <br />SEC. 303(a) <br />I <br />TOTAL <br />00100 <br />PERMVALIDA n,^ <br />WHL"NI PROPERLYIVQALIDATED JO''JJ SPAC.� 1'o 01W ,, QEQIR'Tl'WMIj <br />YOUR RECEIPT-' <br />rQ <br />+HANK YOU ---j <br />8 • 1n <br />APPLIGTION ACWPHO BY: <br />l <br />PLANS CYIECKED BY: APPROVED <br />I <br />I OB IMIJANCE BY <br />- <br />ADDRESS FILE <br />J I "i i 7 <br />