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Ej <br />0 <br />the Evergreen <br />CITY OI' <br />everett <br />CITY HALL 2598745 <br />EVERETT, WA 98201 <br />CONSTRUCTION <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />�e�- <br />evereR <br />OWNER MAIL ADDRESS ZIP PHONE <br />C'ONrPIfORARY CHAA'GFS <br />.9 <br />m <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />3 <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />TM ART DISPLAYS INC 562-2854 25219 <br />z <br />3 <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />CIl IT <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />-Q <br />PERMIT CLASS <br />❑COMBINATION <br />❑BUILDING ❑PLUMBING ❑MECHANICAL <br />OF WORK <br />El NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />5 <br />El DEMOLISH ❑FENCE W SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />FT=TrA-t, SIGN <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY )SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF --' <br />NO, <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />5 1 <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />JOB ADDRESS <br />1512 .S ]ROADWAY SP #47 <br />SPACE & WALL HEATERS - B.T.V. <br />UNIT HEATERS <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHESDRYERS <br />1 <br />VENTILATION FAN <br />RANGEHOOD <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />S <br />I <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />DISH WASHERS <br />I <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />I <br />GAS. SYSTEM: NO OP OUTLETS <br />FLOOR DRAINS <br />I <br />SUBTOTAL S <br />I <br />KITCHEN SINKS & DISP. <br />I <br />eEHM11 5 <br />BAR SINKS <br />TOTAL FEE $ I <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 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 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 CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />/J <br />10— — <br />ROOF DRAINS - RAIN LEADERS <br />SHOWER BATHS <br />I <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />- <br />WATERCLOSETS <br />I <br />WATER HEATERS - ELECTRIC <br />I <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />I <br />I <br />SUB TOTAL <br />PERMIT <br />S <br />TOTAL FEE <br />$ <br />WATERSERVICESIZE <br />BLDG. SUPPLY <br />SIZE <br />SIGNATURE OF CONTRACT OROR AUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YAROSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES WNNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />-. Z <br />NO. OS DWELLING <br />UNIT{ZLt�I <br />I <br />BUILDING <br />$1500.00 <br />I <br />9. 0 <br />SIZE OF BLDG. <br />NO. O STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />3 <br />BASEMENT <br />FIRESPRINKLERS <br />REQUIRED <br />�l'ES ONO <br />MECHANICAL <br />I <br />I <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />PENALTY <br />SEC. 000141 <br />TOTAL ' ' <br />9.00 <br />['�'#.'6 j'4uuFIM ME <br />PERMIT VALIDATION PAC <br />WHEN PROPERLY VALIDATED II 1 <br />XobR RE'CEIrr <br />iw.'RK You � <br />t • � <br />0 t ! t <br />APPUCAT ION ACCH4EO BY: <br />P LADS CIIECNL N BY: <br />APPROVED FOR IMUANCF BY <br />m <br />AUUHt55 r11_C <br />