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The Evergreen <br />GCNSTRUCTI®N <br />CITY OF <br />everett <br />PERMIT <br />PERMIT NO.O7707 <br />CITY HALL 259 8745 <br />❑ COMBINATION BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />EVERETT, WA 98201 <br />OWNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />Kingdom Hall 1730 Madison <br />:.RCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />1 <br />- GENERAL CONTRACTOR MAIL ADDRESS CITY <br />Lynnwood <br />ZIP PHONE LICENSEI <br />98036 353-9000 27151 <br />Sign-)-Lite signs <br />12030 Mukilteo Speadway <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSEI <br />CLASS OF WORK <br />❑NEW <br />ADDITION ALTERATION REPAIR DEMOLITION FENCE <br />❑❑❑❑ <br />pY, <br />[D EIGN ❑GARAGE <br />— <br />VALUATION OF WORT( <br />$ 50.00 <br />DESCRIBE WORK <br />PROPOSED USE OF BUILOING •- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOr RLOCK__OF <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO- <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />JOB ADDRESS <br />6 9 80 <br />/ <br />1730 Madison <br />X <br />PLUMBING <br />MECHANICAL <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 (WASH 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 —BT.U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />— <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — FUUNLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE— BAR. ETC.) <br />' <br />SUBTOTAL <br />SUBTOTAL $ <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />S <br />TOTAL <br />FEE $ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />LIVES VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONET. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$50.00 <br />2 <br />00 <br />SIZE OF SLIDE <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />REQUIRED SPRINKLERS <br />MECHANICAL <br />OYES ONO <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (a) <br />TOTAL .. <br />2 <br />00 <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT �T <br />3223 $002.00 <br />I. <br />5. GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />-YO',U.R RECEIPT c <br />7 jy `rbu <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />HAB <br />- 3 It"� 00 <br />ADDRESS FILE <br />