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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 2598745 <br />EVERETT. WA 98201 <br />CONSTRUCTION Li <br />,1 <br />PERMIT <br />COMBINATION t BUILDING • MECHANICAL • PLUMBING <br />OWNER MAIL AOD11f-`::; ZIP PHONE <br />John F Pickett 5301 West%Highland Road 2528689 <br />m <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />--I <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Same <br />z <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />ED <br />ED <br />m <br />M <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />N <br />Cci <br />PERMIT CLASS <br />❑COMBINATION <br />WUILDING ❑PLUMBING []MECHANICAL <br />OF WORK <br />y�4lyy,� <br />❑NEW [I ADDITION ❑ALTERATION )MREPAIR <br />VALUATION OF WORK <br />S 800.00 <br />❑ DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />Re -roof composition <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY❑GAS ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR PIES) <br />Highland Farms H2 <br />LOT BLOCK —OF <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S_ <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS -H.P. EA. <br />1 <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />JOB ADDRESS <br />5301 West Highland Road <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.U. <br />I <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />i- <br />- -- - <br />VENTILATION FAN <br />RANGE HOOD <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />S <br />1 <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 OF OUTLETS <br />�— <br />FLOOR DRAINS <br />1 <br />SUBTOTAL S <br />I <br />KITCHEN SINKS & DISF. <br />I <br />PERMIT 5 <br />TOTAL FEE S I <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 />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <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 OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />7/13/78 <br />X&EEii%8E <br />X <br />BAR SINKS <br />ROOF DRAINS -RAIN LEADERS <br />SHOWER BATHS <br />I <br />SERVICE SINKS <br />SUMPS --:-SEWAGE PUMP <br />URINALS <br />WATERCLOSETS <br />1 <br />WATER HEATERS - ELECTRIC <br />I <br />WASH BASINS <br />I <br />LAUNDRY TRAY$ <br />I <br />I <br />SUB TOTAL <br />PERMIT <br />S <br />AL FEE <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />SIGNATURE OF CONTRACTOROR'WTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITS DWELLING <br />1 <br />BUILDING <br />S 800.00 <br />B 100 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINK LERS <br />REQUIRED <br />❑YES ❑NO <br />MECHANICAL <br />I <br />I <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />PENALTY <br />'SEC. 000(a) <br />I <br />TOTAL <br />_ <br />"�, <br />_ <br />PERMIT VALIDATION - - <br />WHEN PROPERLY VALIDATED IIN THIS SPA CEITHIS IS Vf1VR PEN 11T <br />L A <br />.CD <br />B i•r, <br />aPPIICwTION ACCf PitU <br />='AFM"05V""O"e'7'UaNGf <br />avb <br />f <br />ADDRESS FILE 9 . f . <br />