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9 <br />rhe £errK�een �-� � � O N ST R U CT I O N� <br />CITY OF � <br />e`�erett PERMIT PERMIT NO. 12707 <br />CITY HALL 759�8745 <br />EVERETT,WA98201 ❑ COMBINATION �X BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL AD�RES!� CITY ZIP PMONE <br />Family Grocer P.O. Box 3763 Seattle 98124 767-8714 <br />ARCHITECT OR DESIGNER MAIL AUOflESS CITV 21P PMONE <br />GENERAL CONTRACTOF MAIL ADDRESS CITY ZIP PHONE ULEHSE � <br />?ieath N.W. Inc. 11805 N.E. 116th Street Kirkland 98033 623-3100 <br />MAIL AGORESS CITV 21P PMONE UCENSE � <br />MEGHFNICAL CONTRACTOR HEATHN*330RT <br />PLUMBING GONTRAGTOfl <br />MAIL ADOPE55 CITV ZIP PHONE LILENSE A' <br />G NE.W ❑ ADDITION ❑ AL7EHATION ❑ REPAIR ❑ DEMOLITION O FENCE �1G�GN ❑ WOOD STOVE/FIREPLACE INSERT <br />.UATION OF WORK <br />y 3.$00.00 <br />LOT__BLOCK_OF <br />9121 Evergreen Way <br />PLUM8ING <br />N0. TYPE OF <br />WATER GLOSET (T <br />BATHTUB <br />LEn <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />LAUNDRYTRAY <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKER3 <br />ROOF ORAINS — RAINI <br />SINK (SERVIGE — BAR, <br />� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />ATfACHfOURCOPIES) C;ORRECT. 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 PRESUMETO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRU ION OR THE <br />PERFOR F NSTR CTION. <br />vIGNATU O . IRAC R�jlliM�2EDAGEN� DPTE <br />// � /i— � /— Y.� <br />MECHANICAL ✓ <br />OR ITEM FEE N0. TYPE OF EOUIPMENI <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILEFS —�H.P. EA. <br />GAS FIRED A.C. UNI7S — TONNAG <br />FORCED AIR SVSTEMS — B.T.U. <br />WALL HEATERS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNI7 — <br />STOVE — WOOD <br />ERS METAL FIREPLACE 8 CHIMNEY <br />� FIREPL4CEINSERT <br />HEAT PUMP <br />TOTAL <br />TOTALFEE <br />- APPROVALS <br />1. ENVIFONMENTAL CHECK LISi <br />2. BUILDING PLANS <br />3, FIRE hIYDRANT <br />1. FIFE PP.OTECTION SYSTEM <br />5. GRADING <br />fi.DRAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />8. HEAITH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKEO <br />I•� <br />� <br />S <br />S <br />aEAR YARD 5 <br />VACANT SITE <br />L;YES CNO <br />NO. OF DWEL <br />MA%. OCC. L( <br />APPR. <br />� <br />EA. <br />il� <br />� <br />GF.M. <br />SUB TOTAL S <br />PEPMIT S <br />TOTALFEE S <br />I NUMBER PLAN CI <br />FEE <br />FEES VALUATION <br />BUILDING <br />PLUMBING <br />MECHAMICAL <br />OTHER <br />PENALTY <br />TOTAL <br />s3,500.00 <br />FEE <br />RFCEIPT NO. <br />FEE <br />15 � 00 <br />15 � 00 <br />rcmm� �..���........ <br />WHEN PRCPEHLV VALI7ATED (IN TH14 4 gCjj TH15!SO�I SP O OT r� <br />D <br />�� <br />� <br />�7��UR REC�IPTri <br />�� ' •"�� K Y C U <br />1 �i"��'i:. <br />ADDRESS FILE <br />Z ? NOY 8 J <br />