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dieErergreen C�NSTRUCTION � -� � <br /> CITY OF <br /> ever�tt PERMI� pERMIT NO. 09121 � <br /> CIN HALL 259-8745 , <br /> EVERETf,WA 58207 ❑ COMBINATION CY�cBUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWNEP MAILAD�flE55 CIiY ZIP .PHONE <br /> Creative Needle 5305 Evergreen Way 98203 355-1919 <br /> ARCHITECi Oii DESIGNER MAIL AOOflE55 Cltt ZIP PHONE <br /> GENERALCANTRACTOP IdAiLADDRE55 QTV ZIP PHONE LICENSEI <br /> Berry Neon Co. Inc. 2102i 61st West Lynnwood, Wa. 96036 776-8835 <br /> MECHAHICAL CONiRACTOP MAIL AUDPESS Gltt ZIP PHONE LICEHSE I <br /> BE RR YN 247J 50 <br /> PLUMBINGfAHTRACTOR MAILADDRE55 CIiV ZIP PMONE UCENSE� <br /> C1A55 OF WOflK <br /> ❑NEW ❑ADDITION ❑ALTERNTION ❑REPAIR ❑DEMOLITION ❑F[NCE C}��,tGN ❑GAMGE <br /> VALUATION OF WOFH <br /> 85�, 0� <br /> ' OESCFIBE WOPK <br /> erect illuminated sign <br /> PROPOSED VSE OF BUILDING <br /> I HEREBY CERTIFI' THAT I HAVE READ AND EXAMINED THIS AP- <br /> LEG�ILDESCRIPTIONOFPflOPEflTY�SMOW BELOWOPATTACHFOURCAPIES) PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDII�ANCES GOVERNING TI�IS <br /> ior BLOGK_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 VIOIATE OR CANCEL THE PRO� <br /> VISIQNS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CpNTP.CiOF OR AUTHOFiIZED AGENT DATE <br /> JOB AD�RE55 <br /> 5305 Ever rren Wa X <br /> PLUMBING MECHANICAL . <br /> NO. TYPE OF FIXTURE OR ITEM rEE NO. TYPE OF E�UIPMENT FEE <br /> WATEF CLOSET(fOILET) AIR COND.UNI75—H.P.EA. <br /> BATHTUB REFRIGERATIOtJ UNITS—H.P.EA <br /> LAVATORY(WASH BASIN) BOILERS—H.P.EA. <br /> SHOWER GAS FIRED A.C.UNITS—TONNAGE EA. <br /> KITCHEN SINK&DISP. FORCED AIR SYSTEMS—B.T.U. M11 EA. <br /> �ISHWASHER N1ALL HEATERS—B.T.U. M <br /> LAUNDRY TRAY UNIT HEATERS—B T.U. �� <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> W�`EF HEATER CLOTHES DRYERS <br /> URIIJAL VENTIIATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS S70VE <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLACE 8 CHIM�EY <br /> SINK(SERVICE—BAR,ETC.) <br /> SUB TOTAL SUB T(1TAL 5 <br /> PEHMIT S PEHMIT 1 <br /> TOTAL FEE S TOTAL FEE 5 <br /> SIDE YARD SETBACK STREETSETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLhN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SI7E <br /> ❑YES ❑NO FEES VALUATION FEE <br /> TYPE OF CANS7. OCCUPANCY GROUP N0.OF DWELLING UNITS <br /> BUILDING 5 850. 00 6 00 <br /> SIZE OF BLDG. NO.OF STORIES MAX.OCC.LOAD <br /> PLUMBING <br /> FIRE ZONE BASEMENT REOUIRED�KLERS MECHANICAL <br /> OYES ❑NO <br /> APPIIOVALS BY DATE OTHER <br /> t. ENVIRONMENTAL CHECK LIST PENALTY U.B.C. <br /> SEC.303(a) <br /> 2. BUILDINGPLANS 6 00 <br /> TOTAL <br /> 3. FIRE HYDRANT <br /> 4. FIFE PROTECTION SYSTEM PEpMIT VALIDATION <br /> WHEN PROPEFLY VALIDATED(IN iH15 SPACE)THIS IS YOUR PERMIT <br /> 5. GRADING G �� i 4 `�� u Q G. O � - � <br /> 6. DRAINAGE N <br /> 7. ENVIRONMENTALIMPACTSTATEMENT � <br /> 8. HEALTH DISTRICT � � �� �' � I r � � <br /> i 0 <br /> APPLICATION ACC.BY PLANS CHECKED BY APPR.FOR ISSUANCE BY .. •'� ` " � u <br /> . ,., i ' <br /> RF BAB <br /> � '! :.�3 Z, I <br /> ADDRESS FILE <br />