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I <br />the Evergreen <br />CITY OF <br />'03"ONS'TRUCTIOP' <br />everett <br />PERMIT <br />PERMIT NO. <br />13851 <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 El <br />COMBINATION %® BUILDING ❑ MECHANICAL ❑ <br />PLUMBING <br />OWNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />SILO 811 SE <br />EVERETT MALL WAY EWRETT <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS .]ITY <br />ZIP <br />PHONE LICENSE N <br />TUBE ART DISPLAYS <br />PO BOX C19013 See+ttle 284-0420 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE N <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />`9 XQ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />I <br />$ 8,000.00 <br />Install sign On east elevatinn <br />PROPOSED USE OF BUILDING <br />' <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 REGU TING CONSTRUCTION OR THE <br />PERFO MANCE OF ON RUCTION. <br />SIGNA OF CONTRACT R0R AGENT PATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT -BLOCK -OF <br />JOB ADDRESS <br />811 SE Everett Mall Way <br />PLUMBING <br />MECAANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS — H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA, <br />LAVATORY BASIN) <br />BOILERS — H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />LAUNDRY TRAY <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 />DRINKSNG FOUNTAIN <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 5 <br />PERMIT $ <br />PERMIT 5 <br />TOTAL FEE $ <br />TOTAL FEE 5 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR 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 />DYES ONO <br />FEES <br />VALUATION <br />_ <br />FEE <br />TYPE OF CONS7. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$$ OOO <br />28 <br />00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />_YES ONO <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 />28 <br />00 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION y� ��pp� p� <br />WHEN PROPERLY VALIDATED (IN TFtISLSpA&E) THI I, Yt9l�RU V U_ <br />u U <br />00 <br />.' R RGCEIPI ;Y <br />, ' <br />rt�.A 1C.)U <br />5. GRADING <br />G. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS HECKED BY <br />AP,R. F R ISSUANCE BY nv <br />J <br />ADDRESS FILE <br />- it SLY 8 4 <br />