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r <br />6 <br />Ilie Evergree�i <br />��T� GF <br />everett <br />CITY HALL 259�8745 <br />EVERET7, WA 9B207 <br />� �an���-R�.��-rior� <br />PE�M�T <br />❑ COMBINATION � BUILDING ❑ MECHANICAL <br />PERMIT N0. 1437d <br />❑ PLUMBING <br />OWNER �.1NLFDDRE55 CITY IIP PHONE <br />H& R Block 6520 "A" Evergreen Way Everett <br />aRCHITECT OF �ESIGNER MAIL AOOFESS CITY ZIP PHONE <br />GENERAL CONTFAGTOR MAIL ADOflE55 CITY Z�P PMONE UCENSE N <br />Berry Neon Inc. P.O. Box 5269 Lynnwood 98046 776-8835 <br />MECHANICAL CONiFFCTOR MAIL AD�RESS CITY ZIP PHONE LICENSE 1 <br />PLUMBIIJG WNTRACTOR MAIL AOOBESS CITY ZIP PHONE LICENSE N <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR � �EMOLITION ❑ fENCE P�61GN ❑ WOOD STOVEIFIREPLACE INSERT <br />VAWATION OF WORK <br />S 6��.�� <br />Install illuminated si <br />PROPOSED USE OF DUILDING <br />LEGAL DESCRIPTION OF PROPERTY �SMOVJ <br />LOT_BLOCK_OF <br />JOB A�Dh�SS <br />6520 '� A" Evergreen �9ay <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />W n'ER CLOSE7 (TOILEn <br />BATHTUB <br />LAVA'ORY�WASH BASIN� <br />SHON'ER <br />RITCHEN SINK 8 DISP. <br />O�SHNASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />WATER HEATEF <br />URINAL <br />DRINKING FOUNiAIN <br />fLOOR DRAIN <br />VACJUM eREAKERS <br />ROOF DRAINS — (iAINLEADERS <br />31NK (SERVICE — B.1F, E7C.) <br />SUB TOTAI <br />PERMIT <br />TO7AL FEE <br />USE <br />OF <br />FIRE ZONE <br />APPROVALS <br />1. ENVIRONMEN7AL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRAN7 <br />4. FIRE PROTEC710N SYSTEM <br />S.GRADWG <br />fi. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTAI'EMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHE <br />F2F <br />FEE <br />5 <br />S <br />REAR YAqD SE7BAGK <br />"-:YES ;:NO <br />:YES :'.'.NO <br />NV/LNC <br />OATE <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 THIS TYPE OF WORK WILL 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 PFOVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGULATING CUNSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE CONTRACTOfl OR nUTHJRIZEO AGENT OATE <br />X /�'%� _ 1 �- �5� - Fs� <br />NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILEflS — H.P. EA. <br />GAS FIRED A.C. UNITS — 70NNAGE EA. <br />FORCED AIR SVS7E�+15 — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVFPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />flANGEH00D <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOO� <br />METAL FIREPLACE 8 CHIIdNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />PLAIJ CHECK <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TO7AL <br />FEE <br />SUB TOT�iI S <br />PERMIT 5 <br />TO7AL JEE S <br />PLAN CHECK FEE <br />FEE FiECEIPT NO. <br />VALUATION FEE <br />5 600.00 <br />5 <br />��� <br />PEFiM17 VALIDA710N <br />WHEN PROPERLY VALIDATED (IN 7HI5 SpACE) THIS IS YOUR,iPERMIf �� -- <br />�+�_ <br />i' ; <br />8Y , ` <br />F,DCR[5:: FILG <br />7 <br />c <br />