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, � , <br /> dieEvergreen � � C�?-NSTRUCTlf2N - <br /> GTY OF /� <br /> �verett PERMIT pERMIT N0. 0�234 <br /> CITY HALL 259�8745 <br /> EVEflETT.WA 98201 ❑ COMBINhTIOtJ ❑ BUILDING Ig�, MECHANICAL PLUMBING <br /> OWNEF MNILAD�RE55 GIT:' ZIP PNONE <br /> Seattle First National Bank <br /> PRCHITcCT OR DESIGNEP IAAIL ADOPESS ��T� Z�P PH�NE <br /> GENERnLCONTRACTOF MNILAOOBE55 GITY ZIP VHONE UCENSE/ <br /> MECMANICALCANTRACiOR MAILADDRE55 GITY ZIP PHONE IICENSE/ <br /> Holiday Parts Fab-Inc. 401 S. Webster Seattle 98108 763-8500 <br /> PLUMBINGGONiRFCTOR MPILAD�RESS QTV 21P PHONE IICENSE/ <br /> xA0 Lfi DP F 376N0 <br /> GLASS OF WOflK <br /> ❑NEW ❑ADDITION ❑AITERATION ❑REPAIR ❑UCM�7LITION ❑FENCE ❑SIGN GARAGE <br /> YALUATION OF Y/OPk <br /> 5 <br /> �ESCFIBE WOFK <br /> PROPOSE�USE OF BU:LDING <br /> I HEREFJY CERTIFY THAT I HAVE READ AND CXAMINED THIS AP- <br /> LEGALOESCRIPrIONOFPROPEPiV�SNOW�ELOWORARACHFOUflCOPIES{ PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> �oT e�ocK_oF — 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 /> 5019 Evergreen Way CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNAT E OF CONT�OR OR UT�y AGENT DATE <br /> JOB ADDRE55 � <br /> X <br /> PLUMBING M�CHANICAL <br /> NO. TYPE OF'•IXTURE OR ITEM FEE N0. TYPE OF EdUIPMENT FEE <br /> WATER CLOSET(TOILEq AIR COND.UNITS—H.P.EA. <br /> BATHTUB REFflIGERATION UNITS—H.P.EA 6 <br /> IAVAWFY(WASH BASIN) BOILERS—H.P.EA . _ <br /> � SHOWER GAS FIRED A.C.UNITS—TON'.JAGE EA. __ <br /> KITCHEN SINK 8 DISP. FORCED AIR S�STEMS—9.T.U._ M EA. _ <br /> DISHWASHER WALL HEATEP�—B.T.:1. M _ <br /> LAUNDRY TRAY UNIT HEATERS--ki.T.U. M <br /> CLOTHES WASHER EVAPOHATIVG COOLERS 6 00 <br /> WA7ER HEATER CLOTHES DRYERS <br /> URINAL <br /> VENTILA710N FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKER$ STOVE <br /> ROOF�RAINS—RAINLEADERS ME7AL FIREPLACE 8 CHIMNEY <br /> SINK�SERVICE—BAR,EfC.) � <br /> SUB TOTAL <br /> SUBTOTAL S 12 00 <br /> PER�iIT S PEHMIT S 3 00 <br /> TOTALFCE 3 <br /> TOTAL FEE 3 15 00 <br /> PLAN CHECK FEE <br /> SIDE YAPD SEfBACK STREET SETBACK REAR YARD SETBACK PLAN ChiECK NUMBER RECEIPT NO. <br /> FEE <br /> USE ZONE LOT ARF1� VACANT SITE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> 7YPE OF CANST. OCCUPANCY GROUP NO.OF DWELLING UNITS I, <br /> BUILDING $ <br /> SIZE Of BIDCa. NO.OF STORIES MA%.JCC.LOAD <br /> PLUMBING <br /> FIRE ZOk�E BASEMENT REDUIRED KLERS �MECHNNICAL 15 00 <br /> OYES ❑NO <br /> APPPOVALS <br /> BY DATE OTHER <br /> 1. ENVIRONMENTAL CHECK LI5T PENALTY U.B.C. <br /> SEC.303(a) <br /> 2. BUILDING PLANS TOTAL 1S 00 <br /> 3. FIRE HYDRANT <br /> A. FIRE PROTEGiION SYSTEM PEflMIT VALIDATION �- <br /> WHEN PROPERLY VALIDATED(IN THIS SPACE)THIS IS YOUFi PERMIT <br /> � 6. DRA NIAGE B 15 3� S � � 5. O ++ ��'? ! <br /> 7. ENVIRONMENTALIMPACTSTATEMENT � ' � ' N � � <br /> _ i � <br /> 8. HEALTH DISTRICT .S <br /> APPUCATION ACC.BY PL4N5 CHECKED BY APPR.FOR ISSUANCE BY 7�O U�R �FC E i P� <br /> x.c. "tt-1Anl: YOU <br /> r.. <br />