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r <br />L <br />nc� Evergreen <br />��1Y �F <br />everett <br />CITY HALL 259�8745 <br />�- - � �ONSTRUCTIO�` <br />PERMIT <br />PERMIT N0. �4L77 <br />EVERETf. WA 98201 � COMBINATION � BUILDING G MECHANICAL ❑ PLUMBING <br />OWNER MAILAD�RE55 CITY ZIP PHONE <br />The Family Grocery 9121 Evergreen Way Everett 98204 <br />ARCHITECT OR OESIGNER MAII AOORESS CITY 21P PMONE <br />. <br />GEN R TOR MAIL AODRE55 CITY 21P PHONE LICENSE M <br />�7l1pXA70$li Inc. 1515 Iowa Street Bellinghnm 98226 733-1530 <br />MECHFNICAL CONTRACTOR MAIL A�DRESS :ITY ZIP PMONE LICENSE N <br />PLUMBING LONTRACTOP MAIL A��RE55 CITY ZIP PHONE LICENSE N <br />❑ NEW ❑ ADDITION ❑ ALTERA710N O REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIC N ❑ WOOD STOVFJFIFEPLACE INSERT <br />_UATION OF WOI <br />S 62%1.�0 <br />LOT_BLOCK_OF <br />9121 Evergreen Way <br />PLUMBING <br />TYPE OF FIXTI <br />WA7ER CLOSET (TOILEn <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRY7RAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />F! OOR DFlAIN <br />VACU�M BREAKERS <br />ROOF DRAINS — RAINLEA�ERS <br />SINK ISERVICE — BAF, ETC.) <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SVSTEM <br />5. GRADING <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTAT <br />B. HEALTH DIS7RICT <br />LL <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 NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OFi-CAKCEL THE- OVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGUL G�Odtg�7RUCTION OR THE <br />PERFORMPNCEOFCONS <br />SIGNATUREOFCONTqACTOROR I AGENT /J �ATE <br />MECHANICAL �� <br />FEE N0. TYPE OF EOUIPMENT <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 SVSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEA7ERS — B.7.U. M <br />EVAPOFA7IVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLING UNIT — C.F.M. <br />SiOVE — WOOD <br />tr;ETAL FIREPLACE 8 GHIMNEY <br />FIREoLACEINSER7 <br />S <br />f <br />S <br />�YES :SNO <br />REOUIRED <br />�.-=.YES ;::NO <br />BY DAiE <br />PLANS CHECKED BY IAPPR.FOR <br />JEP I LL <br />PLAN CHECK <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE S <br />FEE I RECEIPT NO. <br />FEES I VALUATION I FEE <br />BUILDING S 82i1. 74 SO <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY U.B.C. <br />crc am m� <br />TOTAL I I „I"" <br />PEHMI7 VALIDATION <br />WHEN PROPERLV VALIDATED QN THIS'SPAC� THIS IS �'Ol�R1�E�MlY --N� <br />N <br />N <br />_ �' <br />i � �--i <br />.�� <br />ADDRESS FILE <br />:� <br />� <br />i <br />