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the Evergreen <br />CITY OF <br />everett <br />259-8745 <br />C INSTRUCTION <br />PERMIT <br />PERMIT NQ: 18 U 8 5 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL 1] PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />Safeway Inc. <br />P.O. Box 90947 Bellevue, <br />WA 98008-0947 <br />455-8688 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />Design Dept <br />- Same as d(dffi above <br />_ <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE. <br />KirtleyCole <br />Associates P.O. Box 605 <br />Snohomish 98290 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE. <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />Swanson Mechanical 16831 Mcrae Rd. Arlington 98223 652-7471 SWANSMIB2DA <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ® ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />Plumbing alteration <br />HEATSOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Grocery Store <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 FRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PER ORMANCE OF ONSTRUCTION. <br />SIGNAT11 IT FCACTOR, AU ORIZED AGENT, OR OWNER DATE <br />ONT Y! <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT _-BLocK _ of <br />JOB ADDRESS <br />7601 Ever reen Wa <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNDLG UNITS - H P. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY ( WASH BASIN) <br />BOILERS - B.T.U./HP. <br />SHOWER <br />GAS FIRED A.C. UNITS - B.T.U. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. AI <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />11 <br />FLOOR DRAIN <br />55 <br />00 <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />5 <br />SINK (SERVICE - BAR, ETC.) <br />25 <br />00 <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PULP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />$ <br />80 <br />00 <br />SUBTOTAL <br />PERMIT <br />9 <br />OQ <br />PERMIT <br />TOTALFEE <br />$ <br />_10 <br />9 <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />08/24/87 B:25AM <br />ODOAR67Q0 <br />o6l' <br />SIZE OF BLDG. <br />N, OF STORIES <br />MAX. OCC. LOAD <br />MECHANICAL <br />/ <br />i8695 <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />INVESTIGATION FEE <br />RLW.304(e) $9 <br />.Bo <br />STATE BUILDING SURCHARGE <br />CHECK $91.00 <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />S.H. <br />PLANS CHEIKED BY <br />APPR. FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />TOTAL <br />PFRMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Lo <br />c , <br />Co <br />co <br />Q— <br />ADDRESS FILE <br />