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the Euergreen <br />CITY OF <br />ev�rett <br />259 - F3745 <br />� ;' 1NSTRU�il�fd r <br />�ERMI� <br />PERMIT NO. � J 3 �`� <br />❑ DEMOLITION ❑ COMBINATIOh ❑ BUILDING ❑ MECHANICAL � PLUMBiNG ❑ SIGN <br />OWNEF MRILApDRESS GITY ZIP PMONE <br />Roebling Management 1902 SE Everett, Mall W:�f Everett, WA 98204 <br />nNC .TEGTOF�ESiGNER MAILADORE55 CiT1 21P PHONE <br />GENERAL CONTRACTOR MAIL AODHESS GiY � 21P PHONE LiCENSE M <br />MECHANICAICONTRACTOR MAILAODRE$$ CITY ZIP PNONE LIGENSEX <br />PLUMBIIIGCONTRACiOR MAILApDRE55 CITY ZIP PHONE U(;ENSE• <br />Shoreline Mech. Inc. 11735 15th Ave. NE Seattle, W'A 98125 364-3600 SHOREMI160BF <br />CLA55 OF WORK <br />❑ NEW J ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUIL�ING RELOCATION <br />VALUATIOH OF WORK <br />$ <br />i�9E WORN <br />Plumbing for Ll�erett Mall Expansion - for new Pizza Haven/Bean Pod. Sp. 9 and 4B <br />❑ ELECTRICITY ❑ GAS <br />LOT _ �LOCK _ <br />❑ WOODSTOVE <br />FOUR COPIE51 <br />14U2 SE Everett Mall Way Sp.4 and 4B <br />PLUMBING <br />N� TYPE OF FIXTURE Ofi ITEM F <br />WATER CLOSET �TOILET� <br />BATHTUB <br />LAVATO iY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & OISP. <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />UFIhAL <br />DAINKING FOUN�AIN <br />3 FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAIN$ — RAINLEADERS <br />1z SINK (SERVICE —BAR, ETCJ <br />OY <br />S.H. <br />SUB TOTqL <br />PEFiMIT <br />TOTALFEE <br />LOi <br />60 00 <br />75 00 <br />1� �� <br />85 �� <br />)ESETBACK <br />CANT SITE <br />YES ❑ NO <br />OY <br />❑ OTHER <br />I HEREBY CcRTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLIrATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BF. COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PREfiUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL L REGULATING CONSTRUCTION OR <br />THE���NCE F C��UCTION. <br />SIGNAT F ON AGTO.�UTHORI A Nl'.OliOWNER UATE <br />X , � �,�.� ,� Ja -1S=A' <br />TVPE OF EOUIPMENT _ <br />A/C — A/HN�LG UNITS — H.P. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — B.T.U./H.P. <br />3AS FIFED A.C. UNITS -- B.T.U. <br />FORCEDAIRSVFTEMS—B7.U. MEA. <br />WAILHEATERS—�.T.J. M <br />UNITHEATERS—BS.U. M <br />EVAPORATiVE COOLEflS <br />CLOTHES�RYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOCDSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIPEPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />BUILDING <br />PLUMBING <br />SUBTOTAL <br />PEHMIT <br />FEES VALU/.71UN <br />� <br />MECHFNICAL <br />INVES7IGATION FEE <br />STATE BUILDING SURCHARG <br />STATEENERGYSURCHARGF <br />DRIVEWAY PERMIT <br />TOTAL <br />Sea 3a4(e) <br />FEE <br />RECEIPT PJO. <br />FEE <br />WHEN PROPERLV VALIDATED (IN THIS SPACE) THIS IS YOUfl PERMIT <br />AOOi;ESS I IL� <br />fiS <br />