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�,,e�,.�,x,�e,� ^,pNSTRUCTIO�'� _ <br />ciTv or i <br />ever�tt PERMIT PERMIT N0. 12�70 <br />CITY HALL 259�8745 <br />EVERETf. WA 98201 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OVlNER <br />MAILADDflESS CITY ZIP PHONE <br />Randy L. Lervold 6123 Evergreen Way Everett 98203 671-4714 <br />""..._,.._,..,..«��.��o MAILADORESS CITY ZIP PHONE <br />GENERALWNTaAGTOR MAILADDFE55 GITY ZIV VHONE LILENSEI <br />Pugat Sign Co. 2012 State Street Bellingham 98225 733-9500 <br />IAAILAOOHESS GITY 21P PHONE LICENSEM <br />MECHANICAL GONTRAGTOR . <br />PIUMBIN6 CONTRACTOR MAIL ADDRESS GRY ZIP PHCNE LICENSE [ <br />O NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIF ❑ DEMOLITION ❑ FENCE �(}(SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />S 3,000.00 <br />Install illuminated sign <br />LOT_BLOCK__OF <br />6123 Evergreen Way <br />PLUMBING <br />N0. TYPE OF FIXTUHE <br />WATER CLOSET (TOILEn <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNORYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />VACUUM 6REAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK ISERUICE — BAR, ETC.) <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING ThIIS TYPE OF WORK W'LL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL W RE TING CONSTRUCTION OR THE <br />aGacn�GE �NSTRUCTIQ�J. A <br />MECHANICAL <br />FEE NO. TYPE OF E�UIPMENT <br />AIR COND. UNI7S — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED Alfl SVS7EM5 — B.T.U. M EA. <br />WALL HEATERS — B.T.U. �'1 <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLO7HES OFiYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — VdOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />TOTAL � <br />NIT S <br />GL FEE S <br />SETOACK REAR YARD SI <br />?q VACAN7 SITE <br />❑VES 7N0 <br />�NCY GROUP NO. OF DWELI <br />STORIES MAX. OCG LO <br />:NT FIRE SPRINKL <br />REOUIRED <br />'_;YES �:�NO <br />BY <br />1. ENVIRONMENTAL CHECK LIS7 <br />2. BUILDING PLANS <br />3. FIRE HY�RNNT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTA7EMENT <br />e. HEALTH �ISTiiICT <br />APPLICATION ACC. BY PLANS CHE( <br />RF <br />fORI <br />NV <br />SUBTOTAL <br />PEflMIT <br />TOTAL FEE <br />FEE <br />VALUATION <br />BUILDING 53�000.00 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />� <br />5 <br />S <br />CHECK FEE <br />RECEIPT NO. <br />FEE <br />12 00 <br />PENALTY SEC.303(a) <br />TOTAL 12 00 <br />AEHMIT VALIDATION <br />WHEN PROPERLY VALIDATEO (IPI THI$ $P�4C�) THI�$�Y�UF� P[�F7�11i L(fl <br />4 6 I U L IJ U -T <br />� <br />C+,i <br />SIGN TO BE ALL 00 PRIVAT� �EIiPPERTY..�IPT +—� <br />1"C! J IC I:��• <br />n � � {'� <br />NO PROJECTION TO BE PERMITTED�OVER'F LIC <br />RIG[iT OF WAY. <br />ADDRESS FILE <br />Z 8 ��a�r s 3 <br />