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the Evergreen CONSTRUCTION <br />everett PERMIT PERMIT N0. 11004 <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNEfl MAIL ADDRESS CITY <br />ZIP PHONE <br />Everett Flowers 4522 Evergreen Way Everett 98203 252-3668 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CRV <br />ZIP PHONE <br />SigRESS <br />n ORILite Signs <br />12030DMukilteo <br />Speedway <br />Lynnwoold <br />PHONE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />IP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />SI GN OL S245p0 <br />CRY <br />ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />❑NEW ❑ADDITION <br />❑ALTERATION ❑REPAIR <br />❑DEMOLITION <br />❑FENCE ❑SIGN <br />❑GARAGE <br />VALUATION OF WORK <br />a XKXXXg;EBHi#}i8uxxWxj[X <br />11500.00 <br />DESCRIBE WORK <br />Erect I11Uminal-nA (Zin_ <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />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 VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUR OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X 1 G <br />MECHANICAL +S <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOURCOPIES) <br />LOT. RLOCK_OF <br />JOB ADDRESS <br />4522 Evergreen Way <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS— H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS —:TONNAGE EA. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — M <br />B.T.U.COULERS <br />CLOTHES WASHER <br />EVAPORATIVE <br />WATER HEATER _ <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C. F1d <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR. ETC.) <br />w <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />HEAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CLNST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />s 1500.00 <br />9 <br />00 <br />SIZE OF BLDG. <br />N0. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES ONO <br />MECHANICAL <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />PENALTY <br />SEC.03 (a) <br />00 <br />EBYWDATEOTHER <br />3. FIRE HYDRANT <br />TOTAL <br />9 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS A E);HIS IS OUR PERMIT � CD/ <br />, J !Vp D 4 Q <br />VI\M1eCW�C},!-.1 <br />-YO R Tf[:/�.i EJPT� <br />THANK I ,V <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC, BY <br />PLANS CHECKED BY <br />RF <br />APPR. FOR ISSUANCE BY <br />NV <br />6 SEP 81 <br />ADDRESS FILE <br />