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PPLICATION FOB° <br />CITYthe �R CONSTRUCTION BY°F°" <br />cln of <br />everett PERMIT e <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED !'I INK- PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION <br />N BUILDING <br />❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />Arnold R. <br />Kegel 9800 Evergreen <br />Way <br />Everett <br />98204-3894 <br />353-1119 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />?32-04 KE-G <br />KeRel & Associates, Inc. - 9500 <br />Evergreen Way <br />Everett <br />98204-3894 <br />353-1119 <br />LI-*212DF <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />Owner <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />N/A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION @ ALTERATION 10 REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MAI ERIALS PLUS LABOR) <br />$70,000.00 <br />Repair and Restore Fire Damage with Enclocnre and Finish of <br />USE OF BUILDING <br />Commercial Office-Engineer!ng Services <br />—T— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OFW( TK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE. <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATI GCONSTRUCTION <br />OR THE PERFORMANCE OF CON STRUCTI <br />SIGNATURE ON RACTOR OR UT 12 D AG DATE <br />X <br />4/30/87 <br />APPLICANTS CITY b9SINESS LICENSE NO. <br />#010629 <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOWOR ATTACH FOURCOPIESI <br />LOT �BLacK_oF_ <br />(Attached) <br />PROJECT ADDRESS <br />9800 Evergreen Way <br />PLUMBING _ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-11 P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />_ <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />_ <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 />AIH HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />S10VE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE f CHIMNEY <br />SINK SERVICE -BAR, ETCJ <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT f <br />PERMIT S <br />TOTAL FEE f <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SETBACK <br />I <br />VACANT SITE <br />OYES )6NO <br />!T <br />OCCUPANCY GROUP <br />NO. OF DWELLINi <br />NO. OF STORIES <br />MAX OCC. LOAD <br />UNITS <br />FUN AOC. BY <br />PLANS CHECKED EY <br />APPR. FOR ISSSUUANCEBY <br />'AmucA] <br />I <br />I <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />1C76ILa FEE � �lfi � RECEIPTNO. r���� <br />� I O <br />FEED I VALUATION I FEE , <br />