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The Evergreen CONSTRUCTION <br />CITY OF <br />everett PERMIT <br />CITY HALL 259 8745 <br />EVERETT, WA 98201 COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />I OWNER <br />D <br />ZIP PHONE <br />J.K. Gill 1512 South <br />Broadway <br />m <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />PHONE <br />LICENSE NO. <br />GENERALCONTRACTOR <br />MAIL ADDRESS <br />PHONE <br />LICENSE NO. <br />z <br />MECHANICAL CON T RACTOR <br />MAIL ADDRESS <br />PHONE LICENSE <br />C <br />South End Heating and Sheet <br />Metal 7724 7th <br />NO. <br />Ave. S. Seattle 763-1773 <br />W <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />Ln <br />PHONE <br />T <br />LICENSE NO. <br />SO UT HE H269DJ <br />PERMIT <br />CLASS OF WORK <br />C� <br />Lo <br />El COMBINATION <br />[]BUILDING ❑ PLUMBING [-]MECHANICAL <br />[]NEW <br />❑AnDITION ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />$ <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW <br />OR ATTACH <br />TYPE OF ENERGY <br />FOUR COPIES) <br />❑GAS ❑ELEC. <br />LOT BLOCK —OF <br />NO. TYPE OF EQUIPMENT FEE <br />AIR COND. UNITS-H.P. EA. $ <br />no <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />JOB ADDRESS <br />I <br />SPACE & WALL HEATERS - B.T.U. <br />South1512 Broadway <br />UNIT HEATERS-B.T.U. <br />PLUMBING <br />EVAPORATIVE COOLERS <br />DRYERS <br />VENTILATION FAN <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />RANGEHOOD <br />AIR HANDLING UNIT- C.F.M. <br />HBS <br />bIBATCLOTHES <br />WASHER <br />ISHERS <br />WATERHEATER <br />G FOJNTAINS <br />FAS. BUILT FIREPLACE &CHIMNEY <br />RAINS <br />GAS. SVSTEM: NO OP OUTLETS <br />SINKS & DISP. <br />I <br />SUB TOTAL $ <br />BAR SINKS <br />I <br />PERMIT $ <br />ROOF DRAINS - RAIN LEADERS <br />I <br />TOTAL FEE $ <br />100 <br />SHOWER BATHS <br />SERVICE $INKS <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 />SUMPS - SEWAGE PUMP <br />URINALS <br />I <br />WATER CLOSETS <br />I <br />WATER HEATERS - ELECTRIC <br />I <br />WASH BASINS <br />I <br />OP WORIED <br />OR NOTK HIE GRANTIINGL IED OF A ERM TWITHE DOES NOT THER IPRESUMEE 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 />2/7/79 <br />LAUNDRY TRAYS <br />I <br />I <br />SUB TOTAL <br />PERMIT $ <br />TOTAL FEE <br />WATER SERVICE SIZE BLDG. SUPPLY SIZE <br />SIGNATURE OF CONTRACTOR <br />URAUTH.AGENT DATE <br />SIDE YARDSETBACK STREET SETBACK <br />REAR YARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />-ZONE <br />FEE RECEIPT NO. <br />USE <br />LOT AREA <br />VACANT SITE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />❑YES ONO <br />NO. OF DWELLING <br />FEES <br />VALUATION <br />FEE <br />UNITS <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />BUILDING <br />$ <br />I <br />I <br />PLUMBING <br />I <br />FIRE ZONE <br />BASEMENT <br />FI RESPRINKLERS <br />REQUIRED <br />MECHANICAL <br />OTHER <br />ll I OO <br />❑YES ONO <br />SPECIAL CONDITIONS: <br />I <br />PENALTY <br />SEC. 3031.) <br />I <br />TOTAL <br />:r <br />11 100 <br />PERMIT VALIDATION <br />'DR -A PROPERLY VALIDATED I�asPACE�SAI[If•ftlPERM <br />— <br />1 <br />r <br />'jam'•••• <br />CD <br />t: <br />AVPI ICAiIBN ACCEPILO UY: <br />PLANS CNECCEO UY. <br />APPNOVCp FON IS4IANCC UY <br />_ <br />1 <br />� <br />B <br />ADDRESS FILE :. ' i "' I "o .1? •" <br />