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the Evergreen CITY OF is C(&NNSTRUCTION <br />everett 'PERMIT PERMIT N0. 07363 <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑ COMBINATION lX 9UILOING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP nHONE <br />Foxmoor 1512 S. Broadway. Everett Mall Store #37 _ <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE I ICENSE <br />Berry Neon Co. 21027 - 61st W_, Lynnwood <br />MECHANICAL CONTRACTOP MAIL ADDRESS CITY ZIP PHONE LICCNSEI <br />PLUMBING CONTRALNR MAIL ADDRESS CITY ZIP PHONE LICENSE( <br />CLASS OF WORK <br />MEW ❑ADDITION <br />VALUATION OF WORK <br />$ 500.00 <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE NSIGN ❑GARAGE <br />lnstait sign <br />— <br />PROrOSEO'JSE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />LEGAL DESCRIPTION OF PROPERTY(SHOW BELOW OR ATTACH FOURCOPIESI <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />LOT -BLOCK -OF <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISICNS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />- <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE 0 X#TFACTON OR AUTHORIZED AGENT PATE <br />, n ` <br />JOB ASS <br />St N37 Everett—MallX <br />.V <br />_Store <br />PLUMBING <br />MECH LAICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. TYPE OF EGUIPM NT FEE <br />WATER CLOSET QOILF.T) <br />AIR COND. UNITS — H.P. EA. <br />__ <br />REFRIGERATION UNITS — H.P. EA <br />BATHTUB <br />_ <br />UWATORY (WASH 3ASIN) <br />BOILERS — H.P. EA. <br />_ <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />SHOWER <br />FORCED AIR SYSTEMS —B.T.U. <br />KITCHEN SINK h DISP. <br />_ <br />WALL HEATERS — B.T.U. M <br />DISHWASHER <br />_ <br />UNIT HEATERS — B.T.U. M <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />VENTILATION FAN <br />URINAL <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT — C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />SUBTOTAL _S <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL <br />FEE <br />S <br />SIDE YARD SETBACK STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />(]YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF GONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S 500.00 <br />5 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />— <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE REQUIRED SPRINKLERS <br />MECHANICAL <br />DYES ONO <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC.. (a) <br />TOTAL <br />5 <br />on <br />2. BUILDING PLANS <br />3, FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION WHEN l r Q <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) I$ YOURS U I U <br />o I$ i Ty <br />5. GRADING <br />& DRAINAGE( <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />wo,u? R�CGt <br />T <br />8. HEALTH DISTRICT <br />4 1. r'' "i• <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR, FOR ISSUANCE BY <br />uo <br />1 <br />