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I <br />r <br />L <br />the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 <br />CONSTRUCTIO" <br />PERMIT <br />❑ COMBINATION 5a BUILDING ❑ MECHANICAL <br />PERMIT NO. 14090 <br />❑ PLUMBING <br />OWNER <br />MAIL ADDRESS <br />CITY <br />Everett <br />ZIP <br />98204 <br />PHONE <br />353-8292 <br />Glacier Lanes <br />9630 Evergreen Way <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE N <br />Berry Neon Co. Inc. <br />P.O. Box 5269 <br />Lynnwood <br />98046 776-8835 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE M <br />BERRYN247LD <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />Fry <br />ZIP PHONE LICENSE M <br />cuas .n .vnn <br />❑ NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE :aSIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />VALUATION OF WORK <br />s 6890.00 <br />_ 11 4 1 1 .,... - �A c i 1T <br />PROPOSED USE OF BUILDING <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 />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />LOT --BLOCK-OF <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />P =RMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF NTRACTO R AUTHORIZED AGENT DATE <br />d <br />_ <br />JOB ADDRESS <br />9630 Evergreen Way <br />X l <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />NITS — H.P. EA.BATHTUB <br />TION UNITS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />WYPE <br />H.P. EA.SHOWER <br />A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK & DISP. <br />SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />ERS — B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />_ _ <br />VACUUM BREAKERS <br />STOVE — WOOD <br />— <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUBTOTAL <br />i <br />SUB TOTAL $ <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />SIDE YARD SETBACK, <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ 6890. <br />24 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />MECHANICAL <br />IRED <br />OTHER <br />OYES ❑NO <br />APPROVALS <br />BY <br />DATE <br />U.B.C. <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />TOTAL <br />24 <br />IE <br />00 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS ISPACE) THIS 1�,Y,OUj1 PERT Q <br />I U L `t• <br />5.GRADING <br />; :. u 11 11 Cr, <br />Sign to be all on private property. <br />6. DRAINAGE <br />C <br />c� <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />I1J <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />RF <br />NV/LC <br />ADDRESS FILE <br />61 <br />.j <br />