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r <br />1 <br />I <br />y <br />the Evergreen <br />evereCITY OF <br />tt r �ONSTRUCTIOf. <br />CITY HALL 259 8745 PERMIT PERMIT NO. 12017 <br />EVEHETT, WA 98201 ❑ COMBINATION dK BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Alpine Retreaders 306 S.E. Everett Mall Way Everett 98204 347-5626 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE Y <br />Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE / <br />PLUMBING ION I HAl I OR MAIL ADDRESS CITY ZIP PHONE LICENSE / <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />s N/C <br />DESCRIBE WORK <br />Chanve fo Occunanr_v (T7eP) n9 f_ vv <br />PROPOSED USE OF BUILDING <br />Commercial <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ` iU 5/23/63 <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES( <br />LOT_BLOCK_OF _ <br />JOB ADDRESS <br />306 S.E. Everett Mall Way <br />PLUMBING <br />MECHANICAL <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0.=EOUIPMENTE <br />OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />ATS — H.P. EA.BATHTUB <br />RN UNITS — H.P. EA.LAVATORY(WASH <br />BASIN) <br />B. EA.SHOWER <br />G. UNITS — TONNAGE EA.KITCHEN <br />SINK & DISP.FSTEMS <br />— B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKINrFOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE — WOOD <br />ROOF DRAINS -- RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE BAR, ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />_ <br />SUB TOTAL s <br />SUB TOTAL s <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE s <br />SIDE YARD SETBACK <br />STREET SETBACK <br />PEAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />EYES NO <br />_ <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNIT". <br />BUILDING <br />$ <br />00 <br />00 <br />SIZE OF BLDG. <br />N0. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />.:YES :. NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />00 <br />00 <br />4, FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN TH1 fTjE) THI$I&YIIjI/�i ij�f�.11T I� <br />I/ LL JJ 11 �Uf <br />CD <br />CV <br />YOUR RECEIPT r-A <br />THANK YOU <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />wl <br />r <br />ADDRESS I=11[ <br />2 3 VAY S <br />