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!he Ererxreen <br /> ��iY�F ��''� ��QNSTRUCTIC�I�, � <br /> e�erett PERMIT PEHMIT NO. �-b579 <br /> CITY HALL 259�87a5 <br /> EVERETT,WA 98201 ❑ COMBIhATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br /> OWNEF MAIL A�ORE55 pTV 21P PHONE <br /> HERRUN�DELI 10121 Evereqreen Way <br /> ARLMITECT OR OESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTflACTOR MAIL ADDRESS CITY 21P PNONE UCENSE M <br /> JIM MAP�NING SIGNS 9003 - 220th SW Edmonds WA 9803G 774-1964 <br /> MECMANICAL CONTRqCTOR �AAIL A�ORESS CITY ZIP PHONE LICENSE II <br /> PLUMBIN�GONTRACTUp MAI�AOOHE55 CITV ZIP PHONE UCENSE� <br /> CLA55 OF WORK <br /> O NEW O ADDITION ❑ ALTERATION ❑REPAIR ❑ DEMOLI710N 0 FENCE IXI SIGN G WOOD STOVFJFIREPLACE INSERT <br /> VALUPTION OF WORK <br /> s .��0.00 <br /> �ESCflIBE WORK <br /> Install 2'xl5' wall mounted sign <br /> PROPOSED USE OF BUILDING <br /> R2td11 I HEREBY CERTIFY THAT i HAVE READ AND EXAI.9INED ThiIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> LEGALCESGFIPTIONOPPpOPERTY�SMOWBEIOWORATfACMFOUPCOPIES� CORRECT. ALL PROVISIONS OF LA�NS AND ORDINANCES <br /> LOT_BLOCN_OF 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 PROVISIO S OF ANY OTHER STATE OR <br /> � -r LOCAL LAW EGULAT CONSTRUCTION OR THE <br /> T PERFORMAN F CO UCTION. <br /> JOB AODP SIGNATURE NT T Ui RIZEO AGENT ATE <br /> ��121 Evergreen 41ay Space 8 X <br /> Cu <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WA7ERCLOSET�TOILET) AIR COND. UNITS— H.P. EA. <br /> BATHTUB REFRIGER,ITION UNITS— H.P. [A. <br /> LAVATORY(R'ASH BA91N� BOILERS— H.P. EA. <br /> SNOWER GAS FIRED A.C.UNI7S —TONNAGE EA. <br /> KITCHLN SINK 8 DISP. fORCEO AIR SYSTEMS— B.T.U. M EA. <br /> DISHWASHER WALL HEATERS— B.7.U. M <br /> LAUNORY TRAV UNIT HEATERS— B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATEri HEA7ER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE—WOOD <br /> ROOF DRAINS— RAINLEADERS METAL FIREPLAGE 8 GHIMNEY <br /> SINK(SERVICE— BAR, ETC.) FIREPLACE INSERT <br /> HEAT PUMP <br /> SUB TOTAL S SUB TOTAL 5 <br /> PERMIT S PERMIT 5 <br /> TOTALFEE 5 TOTAL FEE S <br /> SIUE VARD SETBACK S7REETSETBACK REAR YARD SETBACK ^LAN CHECK NUMBER PLAN CHECK FEE <br /> 116612: OB�ANP34i� tX.x� <br /> USE ZONE LO7 AREA VACAN7 SITE <br /> !.:YES :-�.NO FEES FEE <br /> t <br /> TYPE OF CONST. OCCUPAI�CY GROUF NO.OF DWELLING UNITS '��j SI .� <br /> BUILDING a x•7Z <br /> S�ZE OF 01 DG. NO.OF STORIES MAX.OCQ LOAD —�l��i <br /> PLUMBING #�i6S� <br /> FIREZONE BASEMENT FIRESPRItJKLERS MECHANICAL �-� �6•� <br /> REOUIRED <br /> �.:YES [_NO <br /> APPpOVALS BY DATE OTHER ppppp5769 <br /> 1. ENVIRONMENTAL CHECK LIST pEryq�Ty ��17B <br /> ��a� <br /> 2.BUILDING P.ANS - <br /> 3.FIREHYDRAN7 TaTAL �5� 6 OO <br /> a.FIREPROTECTIONSVSTEM PEHMITVALIDATION Q�C S3O.� <br /> 5.GRADING WHEN PROPERLY VALI�ATE�(IN i��f'ACE)����' UR PERMIT �',: <br /> 6.DRAINAGE f�~ <br /> 7.ENVIFONMENTALIMPACTSTATEMENT �f�� <br /> � "1 <br /> 6.HEALTH DISTRICT <br /> APPLICAiION ACC. BY PLANS CHECK:D BY APPR.FOF ISSUANCE BV � <br /> ADDRE�S FILE <br />