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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259.0745 <br />EVERETT. WA 98201 <br />COP&TRUCTION <br />0 IwERM11 o• <br />COMBINATION • BUILDING • MECHANICAL IF PLUMBING <br />everett <br />,e, <br />OWNER MAIL ADDRESS AIL ADDRESS <br />Ed Werlich 4724 Glenhaven <br />ZIP PHONE <br />98203 252-4588 <br />IT <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />PHON` <br />S <br />LICENSE ND. <br />x <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE <br />J. Cross Design 423 <br />Tamarack <br />LICENSE NO. <br />353-8010 JC RO SD 222D3 <br />C <br />MEE HANICAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE <br />LICENSE NO. <br />CJ <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />PHONE <br />t. - R1 <br />x <br />LICENSE NO. <br />PERMIT <br />Cl COMBINATION <br />CLASS OF WORK <br />-- <br />81BUILDING ❑ PLUMBING [:]MECHANICAL <br />17NEW <br />❑ADDITION ❑ALTERATION ®REPAIR <br />VALUATION OF WORK <br />g 1500.00 <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />repair deck <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW <br />FOUR COPIES( <br />OR ATTACH <br />TYPE OF ENERGY <br />❑GAS <br />r. <br />LOT 2 BLOCK_I%len havan <br />❑ELEC. <br />NO. TYPE OF EOUIPMLNT FEE <br />AIR COND. UNI15-H.P. EA. $ I <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. I <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />JOB ADDRESS <br />I <br />4724 Glenhaven <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.U. I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />_ <br />CLOTHES DRYERS I <br />VENTILATION FAN <br />—I'--- <br />NO. <br />TV PE OF FIXTURE OR ITEM <br />FEE <br />RANGE HOOD <br />I <br />BATH TUBS <br />S <br />AIR HANDLING UNIT -C.F.M. <br />CLOTHES WASHER <br />I <br />I <br />DISH WASHERS <br />WATER HEATER <br />DRINKING FOUNTAINS <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />FLOOR DRAINS <br />I <br />_ <br />GAS. SV STEM: NO OP OUTLETS <br />KITCHEN SINKS & DISP. <br />SUBTOTAL § <br />BAR SINKS <br />PERMIT § <br />I <br />ROOF DMRANLCETARDIERSMIN LEADERS <br />__ <br />TOTAL FEE § <br />SHOWER <br />I <br />SERVICSINKS <br />THIS PERMIT OECDM ES NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 170 <br />SUMPS MP <br />DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APWATER <br />PLICATION AND KNOW THE SAME TO 6E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />URINAL <br />WATER <br />I <br />LECTfl IC <br />I <br />WASH B <br />I <br />TYPE <br />HEREIN <br />OR NOT. THOF WORK IE GRANTING LL BE LOF A ERMITIED WITH EDOES NOT THER (PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL. LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />LAUNDFIED <br />R <br />1 <br />x '«" yr <br />TOTAL <br />PERMIT�$/31/79 <br />TOTAL FEE <br />WATER SERVICE SIZE BLDG. SUPPLY SIZE <br />SIGNA URE OF CONTRACTOR <br />OR AUTH. AGENT DATE <br />SIDE YARD SETBACK STREETSETBACK <br />REARYARDSETBACK <br />PLAN HECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />❑YES ❑NO <br />NO. OF DWELLING <br />FEES <br />VALUATION <br />FEE <br />— <br />UNITS <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />BUILDING <br />§ 1500 <br />. 00 <br />15 100 <br />PLUMBING <br />�_— <br />I <br />FIREZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />-- <br />❑YES ONO <br />1 <br />SPECIAL CONDITIONS: <br />LIMAECHANICAL <br />Y <br />SEC. 303(a) <br />- <br />15 IOp <br />PERMIT VALIDATION 0 ­L 1 <br />WHEN PROPS RL Y VALIDATED I IN IO ACE) S PERMIT <br />L ' , <br />oy0=tJ'k RECEtof' <br />THANK YOUJ,) <br />PLANSDIECKEDUY'. <br />71-1-PlICATIONACCIPBOUY: <br />AMROVFDFORITWANCPUY. <br />-p <br />_ B <br />1 wa• 711 .. <br />a,S FILE <br />— I %M I 1 <br />