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theEvergreen • CON�RUCTI0�1 <br />CITY OF • • <br />everett � RM�T PERMIT NO.O�4Z7 <br />pTV HALL 259�8745 <br />EVERETT. WA 98.Ot ❑ COMBINATiON ❑ BUILDING ❑ MECHANICAL PLUAABING <br />OWNER MFiLA�DBE55 GTY ZiP PHaHE <br />John Bergstrom 5903 Lombard _ <br />ARCHITECT OR DES�GNER MAIL ADDRE55 frTy IIP PHONE <br />GENERALCONiPAGTOR MAILAD�RES$ CIiV ZI^ PHONF UCENSEI <br />Same <br />MECNANICALCANTRACiOR MNILADDRESS CITY ZIV PHONE U�ENSEI <br />PLUMBINGCANTRAGTOR MAILADOPESS CITY ZIP PHONE LICENSEI <br />E <br />N ❑NEW ❑ADDITION ❑ALTERATION SSAEPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARA��E <br />WOPK <br />YlOPK <br />Repair water line <br />I OSE OF BUILDING <br />I.EGAL DESCRIPTION OF N��uvtMi <br />LOT BLOGK_OI <br />�oe <br />PLUMBING <br />NO. <br />WATER <br />ROOF <br />SIDE YARD SETBACK <br />r <br />� <br />OF <br />SUB <br />FOUR <br />I HEREBY CERTIFY THF:i I HP�.VE REND AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE 9AME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF V+'JJS A!JD ORDI�ANCES GOVERNING THIS <br />TYPE OF WORK WIL� 9E CO�dPLIED WITH WHETHER SPECIFIED <br />FiEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO 31VE AUTHORITY TO VIOLATE OR CANCEL THE PRO� <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGU�ATING <br />CONSTRUCTION OR THE PERFORN�ANCE OF CONSTRUCTION. <br />SIGtJATUR OF GONiRAC OR OR AUTHORREO AGE� �Ai�- <br />�i 4/a/ao <br />X J�C(�.c/L� � � L.it'i 2 • <br />MECHANICAL <br />OR ITEM FEE N0. 1'YPE OF EOUIPM <br />AIR CONU. UIJIT$ — H P. EA. <br />REFRIGERATION UNIiS — H.P_E <br />—� I 1 I vnu FR5 — H P. EA. <br />STHEET SETBl+CK <br />USE ZONE LOT AFEA <br />TVPEOFCONST. OCCUPANCV GROUP <br />SIZE OF BLDG. NO. OF STORIES <br />FIRE ZONE BASEMENT <br />pPPpOVAlS _ <br />1. ENVIflONMENIAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADING <br />6. ORAINAGE <br />7. ENVIPONMENTAL IMPACT STATEMENT <br />8. HE�LTH DISTi7iLT <br />APPIICP.TION ACC. BY PlANS CHECKED BY <br />9EAR YARD SETBACK <br />VACANT SITE <br />❑YES ❑NO <br />NO. CF �WELLING UI <br />MA%.00C.LOAD <br />FIRE SPFINKL[RS <br />REOUIRE� <br />�LlYES Gh0 � <br />9Y I DATE <br />APPR. POR ISSUANCE BY <br />GAS FlRED A.G UNIIS— IUNNAGt tn. <br />FORCED Alfl SYSTEIdS — BT.U. M E <br />b'JALL H[ATERS — B.T.U. M <br />UNIT HEATERS — BS.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYEFS <br />VENTILATION FAN <br />flANGFHOOD <br />AIR HANDLING UNIT — C.F <br />STOVE <br />METAL FlREPLACE 8 CHIMNEY <br />SUO70TAL <br />PEflMlT <br />TOTALFEE <br />CHECK NUMBER P�� <br />FEE <br />BUILDING <br />MECHANICAL <br />OTHER <br />P'NALTV <br />70TA1 <br />b <br />U.B.C. <br />SEC. 303 (a) <br />flECEIPT N0. <br />5 100 <br />Y l'ALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />049$ aooti.eo -- � <br />� <br />� <br />•Y4UR REC[fPT � <br />rr;tir!� Yo u <br />�4��SG <br />