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I� <br />dir [icrrcrtrn <br />everett <br />CITY HALL 25°�P745 <br />EVEFETi, lVA 98201 <br />��NST�ucTior_ <br />PERI�IIT <br />❑ COMBINATION ❑ BUILDING �X MECHANICAL <br />PERMIT NO. � � � � � <br />❑ PLUMBING <br />OIYNEH M..11L ADORESS CIiY ZIP PMONE <br />Botesh and Nash and Assoc. 9206 Hoyt Everett 98201 <br />aRCniTEGT OR bE51GNEF MAiL ADOFE55 GiTY ZIP PMONE <br />GENEPAL CONTFALIOR MAIL AODHE55 QTY 21P PHONE UCENSE M <br />MECMANICRL CONTRACTOR MAIL ADORES$ GITV 21P PHONE IICEN$E e <br />�:vergreen State Sheet bfetal Inc. P.O. Box 1508 Everect 98206 252-3114 <br />PLUM9ING CONTPPCiOfi MAIL AODRE55 CItY ZIP PHONE UCENSE X <br />F�1 FR CC S"([1_�'3 <br />LLASS OF WORN <br />❑ NEW ❑ I?DDITION ❑ ALTERATION O REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOI�'JFIREPLACE INSERT <br />S <br />LOT _ BLOGN _ _OF <br />JOB FODPESS <br />4206 Hoyt <br />?LUMBING <br />NO. I TYPE OF FIXTURE OR <br />WATER CLOSET � <br />BATHTUB <br />LAVATORYIWAS <br />SHOWER <br />KITCHEN SINK 8 <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />ORINKING fOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — �7FIIJLEADERS <br />SINK (SERVICE — BAR, ETQ) <br />SUB 707AL <br />PERMIT <br />TOTAL FEE <br />BL�G. <br />1. ENVIRONMENTAI CHECK LIST <br />2. BUILDING PLANS _ <br />3. FIflE HYDRANT <br />a. FIRE PROTECTION SYSTEM <br />s cenoiNc <br />6. DRAINAGE <br />7. ENVIRONMENTALIMPACTSTATEh <br />B. HEAITH DISTRICT <br />APPLICATION ACC. BY PLANS <br />I HEREBY CERTIFY THAT I HAVE READ AN� EXAMINFD THIS <br />APPLICATION AND KNOW TI1E SAME TO 8[ TRUE AND <br />COPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDIMANCES <br />GOVEFNING 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 AIJY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIGNAIU� OF CpHTRACTOR OR A'J�i OR12ED FGENT DAT[ <br />// a �� <br />FEE <br />f <br />S <br />s <br />YES .NO <br />MAX. <br />APPR.FOR <br />MECH'ANICAL � <br />N0. TYPE OF EOUIPMENT <br />AIR COND. UNI75 — M.P. EA. <br />REPRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />1 FORCED AIR SVSTEMS — B.T.U. M EA. <br />VJALL MEATERS — B.T.U. M <br />UNIT HEATEFS — B.T.U. M <br />EVAPORATIV� COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHCOD <br />AIR HANDLING UNIT — C.F.M. <br />S70VE — WOOD <br />IdETAL FlREPLACE 8 CHIMIJEY <br />FIREPLACEINSERT <br />>LAN CHE( <br />BUILDING <br />PLUMBING <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />;NUMBER F <br />FEE <br />FEES VALUATION <br />S <br />'tlMJ MECHANICAL <br />DATE OThIER <br />PENALTY <br />U.B.C, <br />SEC. 303 �a� <br />FEE <br />S Fi 00 <br />f <br />f 16 00 <br />CHECK FEE <br />RECEIPT NO. <br />FEE <br />16 00 <br />TOTAL 16 QD <br />PF.NMIT VALIDATION <br />WHEN PROPERLY VALIDATED pN THI$ �PPG�) THI�IS1YQUj7 P�Rty11T �,j� <br />� �) v � f7 �� — 00 <br />N <br />M <br />_ �� I T <br />BY <br />J <br />/�V��\L.IJ I-��L <br />