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• the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 <br />CONSTRUCTIOA everett <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />OWNER MAIL ADDRESS ZIP PHONE <br />Robert Pate 115 Madison <br />.D <br />171 <br />_ <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />M. R. Hessison Roofing 19728 43rd S.E. Bothell 485-BB28 223-MR HA RR 278 <br />z <br />O C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />m <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />0-) <br />PERMIT <br />❑COMBINATION <br />BUILDING []PLUMBING ❑ MECHANICAL <br />CLASS OF WORK <br />❑NEW []ADDITION ❑ALTERATION ❑REPAIR <br />na <br />VALUATION OF WORK <br />920.00 <br />$ <br />'I ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />Re -roof Composition <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY ❑GAS ❑ ELEC. <br />FLEGAL OUR DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />COPIES) <br />LOT �—BLOCK—OF—Airport n <br />NO. <br />EQUIPMENT <br />TYPE F EQUIPMENT <br />FEE <br />AIR COND. UNITS - EA. <br />S I <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />I <br />_ <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />JOB ADDRESS <br />115 Madison <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.U. <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />_ <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGE HOOD _ <br />1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />_ <br />AIR HANDLI14G UNIT- C.F.M. <br />BATH TUBS <br />S <br />I <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />DISH WASHERS <br />I <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />I <br />GAS. SYSTEM: NO OP OUTLETS <br />FLOOR DRAINS <br />1 <br />SUBTOTAL S <br />I <br />KITCHEN SINKS & DISP. <br />1 <br />BAR SINKS <br />I <br />PERMIT S <br />ROOF DRAINS - RAIN LEADERS <br />1 <br />TOTAL FEE S <br />I <br />SHOWER BATHS <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />PRIVATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APWATER <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />/� • /% �{ . 6/2/6/7 <br />X " /1A l.�C LT%L�yyywry� <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />WATER CLOSETS <br />1 <br />HEATERS - ELECTRIC <br />I <br />WASH BASINS <br />1 <br />LAUNDRY TRAYS <br />1 <br />— <br />I <br />SUB TOTAL <br />PERMIT S <br />TOTAL FEE <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />SIGNATURE OF CONTRACTOROR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE (RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES [:)NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />BUILDING <br />SD20.00 <br />10 100 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRESPRINKLERS <br />RE <br />❑YES []NO <br />YES <br />MECHANICAL <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />PENALTY <br />SEC. 703(A) <br />I <br />TOTAL <br />10 100 <br />PERMIT VALIDATION *1�44�� 1. <br />WHEN PROPERLY VALIDATED ONLTj VIPACEUAOIITM1T <br />1f 4 tlR RC�� <br />"7HANK YOOF" <br />1 <br />© 2 i .�r 72 <br />[WUCATIONACCEPTEDUY-. <br />PLANSOIECKLOBY: <br />APPROVED FOR ISSUAWL BY. <br />EB <br />ADDRESS FILE <br />i <br />