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the E�ergreen <br />cirv oF <br />everett <br />259-8745 <br />_ ('.�NSTRI���'C�J(V <br />��Rn��1r PERNiITNQ:_.' 77o'T <br />❑ DEMOLITION ❑ COM9INATION ❑ BUILDING ❑ MECHNNICAL ❑ PLUMBING ❑ SIGN <br />OWNEfl MAIIADDRESS CITY ZIP PMONE <br />David A Brandvold Box 3066 Everett, WA 98703 355-6000 <br />ARCHITECT OR OESIGNER MAIL ADDRESS CITY TIP PMOhc <br />Gary Parkinson 527 Med Dental Bldg. Everett 252-2153 <br />GENEHALCONTRACTOF MAILAOORE55 CITY 21P PHPNE �ICENSEn <br />D.A. Brandvold Bo:: 3066 Everett, [9A 98203 <br />MEGHANICALLONTRACTOR AfAILADOBE55 CITY ZIF PHONE LICENSE� <br />PWMOINGCONTHNCTOR MAILApOflE55 CITY ZIP PHONE UCENSE• <br />CLASS OF WORK <br />❑ NEW O ADDITION <br />VALU4TION OF WONK <br />$ ai��0 <br />Build new rest room <br />NEAT SOUliCE <br />❑ ELECTRICITY <br />warehouse <br />3 & 4 5 <br />LOT __ BLOCK _ <br />��� Eveigreeh Way <br />PLUMBIYG <br />No. <br />$7 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILJING RELOCATION <br />partial walls repair sliding track doors <br />❑ GAS ❑ WOODSTOVE ❑ OTHER <br />N pELOY/ OR ATTACR FOl1R COPIES� <br />Heverly Hills t;2 <br />OR ITEM � FEE <br />WATER CLOSET (TUILET� <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SH0IVER <br />NITCHEN iINK & OIS?. <br />OISHV/ASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />11RWAL <br />DRINKING FOUNTAIN <br />FLOOR DHAIN <br />BACKFLOI"lPREVENTERS <br />ROOP DRAINS — RAINLEA�ERS <br />SINK (SEr7VICE — BAR, ETC.) <br />USE20NE <br />B�Z <br />TYPE OF CONST. <br />V-N <br />��°o�`gG+ icoo <br />FIRE SPRINKLERS PEO� <br />APPLICAT�ONACC �Y <br />SU9TOTAL <br />PERMIT <br />TOTALFEE <br />ZLZi�O� <br />I HEAcBY CERTI=Y THAT I HAVE READ ��JD [XAMINED THIS <br />APPLICATION AN7 KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALi PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED fiEREIN OR NOT. THE GRANT'NG OF A <br />PERMIT DOES MOT PRESUME TO GIVE AUTHURITY TO <br />LA', E OR .ANC L E PROVISIOWS C�� P.NY OTHER <br />TA AI EGULATING CO�v� �� ^�CTION OR <br />T E P� � C NSTRUCTION. /� w <br />a GN� RE � N. TOr�. AU M IZEOAGENT.OR OWNEVYJ� �/ _�Dry�/ �� <br />X G—� -� : <br />7� � <br />i�AECHANIf;AL � <br />iVO. TYPE OF EOUIPM�NT <br />A/C—A/iNOLGUNITS—H.P. � <br />REFRIGEFATION UNITS — H P. EA. <br />901LERS — B.T.U./M P. <br />GAS FIREO A.C. UNITS —B.T.U. <br />FORCED NR SVSTEMS — B T.U. M EA. <br />WALLHEATERS—B.T.U. M <br />UNITHEATERS—BT.U. M <br />EVAPOflATIVE COOLERS <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER • <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUh1P <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />SETBaCrc pLAN CHECK NUM�ER FEE <br />- 87/17707 64.35 <br />VACANT S�TE <br />❑VES RTNO <br />�A7-� '�' . -n 0 <br />� <br />ST qIE� h1AX � Lpqp <br />+ mezz `�`� <br />MxMx S.H. I IIe <br />APPP �OR ISSUANCE �Y <br />L.0 <br />SEPARATE PLUMBING AND MECHANICAL PERMITS <br />WILL BE REQUIRED. <br />BUILDINC <br />PLUMBIIJG <br />FEE <br />RECEIPT NC. <br />83523 <br />FEES VALUATION FEE <br />5 8,000. 99 00 <br />MECHANICAL <br />INVESTIGATION FEE �jp§���]I� <br />STATEBUILDINGSURCHARGE �� �'S����UU <br />• c •r�u c cn <br />STATEENERGYSURCHARGE �HECY, ;SO�.SO <br />TOTAL I I I�'�y�` <br />PEqN�1T VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) TMI515 VOUR PERMIT <br />f;GDRE55 FlL? <br />1I50 <br />