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die£reCrTmon �- '��NSTRUCTIOt�' <br />everett pERMIT PERMIT N0. 1255� <br />CITY HALL 259�8745 <br />EVERETT, WA 98201 ❑ COMBINATION �t BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MPILAOORE55 CITY ZIP PHONE <br />United Pack N Ship 9021 Ever reen Wa Everett 96201 355-4414 <br />APCHITEGT OR OESIGNER MAIL ADDRE55 CITY 21P PHONE <br />GENERALCONTRACTOR MAILADDRE55 CITY ZIP PMONE UGENSEM <br />Puget Sign Co. 2012 State Street Bellingham 98225 733-9500 <br />MECHANICAL CONTPACTOF MAIL ADDRE55 CITY 21P PHONE LICENSE X <br />PUGETSC189DP <br />PLUMBING GONTflAGTOR MAII A�DRESS CITY ZIP PHONE UCENSE M <br />❑ NEW O ADDITIOt� ❑ ALTERATION ❑ REPAIR ❑ �EMOLITION ❑ FENCE jt,�(SIGN O WO00 STOVEIFIREPLACE INSERT <br />f 1,100. <br />install sign <br />LOT_BLOCK_OF <br />9021 Evergreen Way <br />PLUMBING <br />USE <br />SIZE <br />OF FIXTURE <br />WATER GLOSET (7oi�t i ) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KI7CHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRVTRAY <br />CLO7HES WASHER <br />WATER HEAIER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BfiEAKERS <br />FOOF DRAINS — RAINLEADERS <br />'i SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />STREET SETBAI <br />LOT AREA <br />OCCUPANGY G <br />NO. OF STORIE <br />1. ENVIRONMENTAL CHEGK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. DRAINAGE <br />7.ENVIRONMEN7ALIMPACTSTATEMENT <br />B. HEALTH OISTRICT . <br />RF <br />� <br />S <br />5 <br />aEAR YARD S <br />VACAN7 SI7E <br />i:YES GNO <br />NO. OF DWEI. <br />MAX. OCC. L( <br />FIRE SPRINKI <br />REOUIRED <br />�:�VES �::NO <br />APPR. FOR <br />NV <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 hOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAVJ REGULATING CONSTRUCTICN OR THE <br />PE�F�RMANCE OF CONSTRUCTION. <br />rnuraenrnaowni�i(iIZEOAGENT �TE / <br />N0. TYPE OF E�UIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T:J. M EA. <br />WALL HEA7ERS — B.T.U. N1 <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE G�OLERS <br />CLOTHES DRYEFiS <br />VENTILATION FAN <br />FANGEHOOD <br />AIR HAN�LING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />SUB TOTAL <br />PEFMIT <br />TO7ALFEE <br />ECK NUMBER P <br />F�E <br />FEES VALUATION <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />S <br />U.B.C. <br />SEC. 303 <br />FEE <br />� <br />5 <br />S <br />�HECK FEE <br />RECEIP7 NO. <br />FEE <br />9 <br />TOTAL 9 �0 <br />PERMIT VALIOATION <br />WHEN PRUPERLY VALIDATED �IN 7H� 9 5 1E) THIS � OY� �. O O�71T � <br />D <br />l.f� <br />�� <br />B„ yOU't RECEIPT "� <br />I F �,�''.:��!� �7 C' U <br />ADDRE�S FILE <br />� 3 OCi 8 � <br />