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d�c Everxreen <br />��T�oF '�� � CONSTRUGTI�°N <br />everett PERMIT PERMIT N0. 1594� <br />CITY HALL 259�8745 <br />EVERETT,WA98201 � COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAILADDRE55 CITY ZIP PMONE <br />Community Dental Center 520 S.E, Everett Mall Way Everett 98204 <br />ARGHITECT OR OESIGNEP MAIL ADDRE55 CITY ZIP PHONE <br />GENERALCONTflACTOH MAILADDRESS CITY 21P PMONE �ICENSEN <br />Jim Manning & Assoc 9003 220th S.W. Edmonds 98002 774-1964 <br />MECHANICAL CONTRACTOR MAIL ADDRE55 CITY ZIP PHONE LICENSE r <br />JINAfAA208MB <br />PUIMBING CONTRACTOR MAIL AUORESS CITY ZIP PHONE LIGENSE N <br />❑ NEW ❑ AODITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE �SIGN ❑ WO00 STOVEIFI(iEPLACE INSEfiT <br />s 3000.00 <br />Install illuminated sign <br />PflOPOSEU USE OF BUILDING <br />LOT <br />PLUMBING <br />NO. TYPE OF FIXTUIiE OH ITEM <br />BATHTUB <br />LAVATORY(WASHOA: <br />SHOWER <br />KITCHEN SINK 8 �ISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS - RAINLEAOERS <br />SINK �SERVICE - BAR, EfC.) <br />SUB TOTAL <br />PEHM�7 <br />TOTALFEE <br />APPROVALS <br />7. ENVIRONMENTAL CHECK LIST <br />2. BUILOING PLANS <br />5. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. ORAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <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 />GOVFRNING 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 />SIGNATU E O CONTRACTOR OR AIITH PIZED AG NT OATE <br />x � �, s:l�� -- �—/�e � <br />MECHANICAL <br />FEE � NO. TYPE OP E�UIPMENT <br />AIR COND. UNITS — H.P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DHYERS <br />VENTILA710N FAN <br />S <br />S <br />S <br />uYES ❑NO <br />AIR HANDLING UNIT - C.F.M. <br />STOVE - WOOD <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUF�P <br />SUBTOTAL 5 <br />PEHMIT 5 <br />TOTAL FEE S <br />;HECK NUMBER PLAN C <br />FEE <br />FEES VALUATION <br />BUILDING <br />C.LOAD <br />PLUMBING <br />iINKLERS MECHANICAL <br />D <br />CNO <br />DATE O7HER <br />PENALTY <br />PLANS CHECI!ED BY APPR. FOR ISSUANCE BY <br />r�v/Lxc i/is/ae <br />53000.00 <br />RECEIPT NO. <br />FEE <br />12 I 00 <br />TOTAL I I 12I 00 <br />PEHMIT VALIDATION <br />WHEN PROPERLV VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT � <br />Sign to be all on PaSii���t� Pr���t�.0 Q—� <br />� <br />�'� �... .. _ r-'i <br />�. �._:l:L�,"I <br />� . .. ... �I �. ' i <br />v,DDRESS FILE <br />�, ,� , � : <br />., �,._, „;, <br />