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/�+. <br /> ��1 <br /> tlie Evergmen �*�N S�'R U CTI O N <br /> CITY Of <br /> �,verett P�RiVIIT PERMIT N0. OH7�O <br /> CITY HALL 259�8745 <br /> �VERETT,WA 98201 ❑ COMBINATION �xBUILDING ❑ MECHANICAL ❑ PLUMBING <br /> Ot'INER MAILADDRE55 CIiV ZIP PMONE <br /> George R. Seferos 145 N.W. 85th Seattle 98117 ��3-54a9 <br /> FFCHITECT ON�ESIGNER MAILADDRESS CITY ZiP PHONE <br /> GENERALCONiRALTOR MAILADDRESS CITY ZIP PHONE LICENSEI <br /> Same <br /> !d[CHANICALCON�FACTOF MAILADDRE55 CITY ZIP PMONE UCENSEI <br /> PLUl.1�INGCONTRACTOR MAILA��RESS CITY ZIP PHONE IICENSEI <br /> CLFES OF WOflK ' <br /> ONEW ❑ADDITION K}G.LTERATION ❑REPAIR ❑DEMOLITION ❑FFNCE ❑SIGN ❑GAqAGE <br /> VPLUATION OF WORN <br /> b25 � ���. �� <br /> OESCRIBE WORN <br /> interior remodel <br /> Pa0PO5ED USE OF BUIIDING <br /> ^ommercial I HEREBY CERTIFY THAT ! HAVE READ AND EXAMINED THIS AP- <br /> LE3/LDESCPIPTIONOFPROfERTY�SHOWBELOY/ORATTACHFOURWPIES) PJCATION AND YNOW THE SAME TO BE TRUE AND CORRECT. <br /> 7. Beverly Garden Tract ALL PR�VISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> �or eia�_oF — TYPE OF WORK WILL BE COMPLIED NqTH WHETHER SPECIFIED • <br /> HEREIN OR NOT. THE GRANTING CF A PERMIT DOES NOT <br /> P�ESUME 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 CCNSTRUCTION. <br /> Jv3FD�P[55 SIGNAi OFCONTpACTORORAViHOFIZEDFGENi DATE <br /> 8701 Evergreen Way X' � _� ��yy�J 12/�4/80 <br /> PLU�ABING MECHANICAL -- <br /> NU. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> V✓ATER CLOSET(TOILET) AIR COND.UWTS—H.P.'cA. <br /> BATHTUB REFRIGERATION UNITS—H.P.EA <br /> LAVF.TORY(WASH BASIN) BOILERS—H.P.EA. <br /> SHOWER GAS FIRED A.C.UNITS—TONNAGE EA. <br /> 1 KITCHEN SINK 8�ISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> f��l DISHWASHER WALLH[ATERS—BT.U. M <br /> � t� LAUNDRY 7RAY UNIT HEA7ER5—B.T.U. M <br /> �S CLOTHES WASHER E'JAPORATIVE COOLERS <br /> WATER HEATER CLO7HE5 DRYERS <br /> URINAL VENTILATION FAN <br /> DFINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDUNG UNIT— C.F.M. <br /> � VACUUM BREAKERS STOVE <br /> ROOf DR.41NS—RAMLEADERS METAL FIREPLACE&CHIMNEV <br /> SINI:(SERVICE—BAR,ETC.) <br /> SUBTOTAL SUB TOTAL 5 <br /> PEHMIT S PERMIT 5 <br /> TCTAL FEE S TOTAL FEE S <br /> SIDE YAPD SETBACK STREET SETBACK fiFAR YARD SET3ACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> USEZONE LOTAFEA VACANTSITE ,��8720 ��110 .83 R�1PS03 <br /> I ❑YES }(�pJO FEES VALUATION FEE <br /> ( TYPE OF CCNST. OCCUPANCY GROl1P N0.OF DWELLING UNITS <br /> V-N B-2 p <br /> BUILDING s25 ,0U0 .0 170 50 <br /> SIZE OF BLDG. NO.OF STORIES MA7(.00Q LOAD <br /> 1 PLUMBING <br /> .i FIRE ZONE BASEMENT FIRE SPPINKLERS <br /> REOUIRED MECHANICAL <br /> ❑YES XIRNO <br /> APPHOVALS BY DATE OTHER <br /> t. ENVIRONMENTAL CHECK LIST PENA�n. U.B.C. <br /> 2. BUILDINGPLANS SEC.303(a) <br /> 3. FIRE HYDRAN7 T�TA� 1']O S O <br /> 4. FIRE PROTECTION SYSTEM PERMIT VALIDATION <br /> WHEN PRG:'�IiLY VA�IDATED(M THIS SPACE)THIS IS YOUR PERMIT <br /> 5. GRADING 7 5 <br /> 6. DRAiNAGE 1 � � 6 � I " 0• " O —� <br /> N <br /> 7. ENVINONMENTALIMPACT S7ATEMENT � � <br /> P. :�EALTH UI3TRICT _ � � �� ��_� �� � p��O <br /> �_ i i � <br /> APFLICATION ACC.BY PIANS CHECKE�BY APPR.FOR ISSUANCE BY , , ��� �� _ <br /> V.C. _ . . , I� <br />