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the Evergreen <br />CITY Ob <br />everett <br />CITY HAIL 2598985 <br />EVERETT. WASHINGTON <br />98101 <br />DEPT. JF COMMUNITY BUILDING <br />DEVELOPMENT <br />CONS I RUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING ,e., <br />OWNER MAIL ADDRESS ZIP PHONE <br />.itstern sl�shin ;:•ar1 7th :a_v Arl"nt Est 4414 woodlaw, <br />4 1 Park iarth <br />�? <br />1036-. <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE L! NSE NO. <br />'� ;W36Seattle, <br />i?r. . oora .. -11 <br />GENEgAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />' <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />cc <br />UJ <br />m <br />PERMIT <br />❑ BUILDING ❑ PLUMBING ❑ MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION 4ALTE RATION ❑REPAIR <br />Z <br />F <br />VALUr.T1ON OF WORK. <br />5 `ORKS3O. Obi <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />cc <br />LU <br />a <br />DESCRIBE <br />741;4oao1 2 existing rooms into a `S !;oon <br />2855 <br />PROPOSED USE <br />MothurIs '_'.DOffi <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY IS HOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCKOFAttached <br />TYPE OF FUEL ❑OIL ❑NAT ❑LPG. ❑ELEC. <br />GAS <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S I <br />REFRIGERATION UNITS-H.P. EA. <br />—T <br />BOILERS-H.P. EA. <br />I <br />) <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />I <br />j <br />JOB ADDRESS <br />4132 adaral <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-R.T.U. M <br />EVAPORATIVE COOLERS <br />I <br />- <br />PLUMBING <br />CLOTHES DRYERS <br />VENTILATION FAN <br />I <br />RANGE HOOD <br />AIR HANDLING UNIT- C.F.M. <br />1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />g <br />INCINERATOR <br />I <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />1 <br />SHOWER <br />KITCHEN SINK & DISP. <br />SUBTOTAL S <br />1 <br />DISHWASHER <br />PERMIT 5 <br />LAUNDRY TRAY <br />TOTAL FEE $ <br />I <br />CLOTHES WASHER <br />WATER HEATER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IFO <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTEI: WORK IS COMMENCED. <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 />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />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 REGULATING COI"iTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />�— <br />X���� ?/2O/," <br />URINAL <br />DRINKING FOUNTAIN <br />— <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />S <br />TOTAL FEE <br />5 <br />SI NATUREOF CONTR CTOROR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETBACK <br />PLAN CHECK NUMBER <br />77/439 <br />PLAN CHECK FEE <br />FEE _ RECEIPT NO. <br />*7'53 23425 <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />I <br />BUILDING <br />S 1� 7:)a• Of) <br />151 OO <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX.00C. LOAD <br />PLUMBING <br />I <br />FIRE ZONE <br />BASEMENT <br />FIRESPRINKLERS <br />REQUIRED <br />DYES ONO <br />MECHANICAL <br />I <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />I <br />PENELTY <br />SEC. 3031a) <br />I <br />TOTAL <br />1 5 : 1�4 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />APPLICATION ACCEPTED BY: <br />PLANS CHECKED BY: APPROVED <br />FOR ISSUANCE BY. <br />