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the Evergreen C GA T R U C TI O N <br />- °'•'"°' � everett PERMIT <br />CITY HALL 7D9 0745 <br />EVERETT. WA 08201 COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />OWNLB MAIL AUUHL55 ZIP PHUNL <br />l A �r% / G'J[� G <br />je .�1 1 v 1 4 i✓ 1 2 Q L1 ! 4 Y V 2 �% 2^ Z JS Z <br />� <br />ITT <br />AHCHITECT OR DESIGNER MAIL ADDRESS PIIONL LICENSE NO. <br />.= 3 O/1 <br />GENERAL CONTRACTOR d MAIL ADDRESS PHONE LICENSE NO. <br />/ZZ AI.z <br />c <br />MECHANICAL CONTRACTOR AIL ADDRESS PHONE LICENSE NO. <br />5 <br />W <br />TR <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />COMBINATION <br />[]BUILDING ❑PLUMBING ❑MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION OFWORK <br />❑DEMOLISH ❑FENCE []SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />e <br />3s2 7 <br />PROPOSED USE <br />r <br />I I% r .n G r <br />MECHANICAL <br />TYPE OF ENERGY <br />❑GAS ®,ELK. <br />LE nl. DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) n <br />LOTS ALOCKOF ' •wl, 1. 3 <br />`" �'? �•'yl� (r/ 1' <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />AIR CUNIJ. UNITS-H.P. EA. <br />S I <br />REFRIGERATION UJHT5 H.P. EA. <br />BOILERS H.P. EA. <br />I <br />n C w %7-. .. <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />- <br />I <br />JOB ADDRESS <br />362-11 Rol tofve1 <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS R.T.U. <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />ELOn1E_s DRYERS <br />1 <br />_ <br />/ <br />VENTILATIONFAN <br />RANGE HOOD <br />I / <br />N <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING VN11 - C.F.M. <br />BATH TUBS <br />S <br />I <br />CLOTHES WASHER <br />1' <br />WATER HEATER <br />DISH WASHERS <br />1 <br />-- <br />--- <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />1 <br />GAS. SYSTEM: NO OP OUTLETS <br />FLOOR DRAINS <br />-SUBTOTAL 5 <br />_- <br />I� <br />KITCHEN SINKS & DISP. <br />_ <br />BAR SINKS <br />1 <br />PERMIT 5 <br />ROOF DRAINS - RAIN LEADERS <br />1 <br />TOTAL FEE SI <br />1/ <br />SHOWER BATHS <br />THIS PEFIAIIT BECOMES NULL AND VOID IF WORK OR CONSTRUCG <br />TION AUTHORIZED IS NOT COA•MENCEO WITHIN 120 DAYS. OR IF <br />CONSTRUCTION OH WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 170 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREIN CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATION AND Y,NOIV 111E SAME TO 11C 1 RUE AND CO RRECI'. AL1. <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED Wl rH 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 011/ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERI'ORMANCE OF CONSTRUCTION. <br />�J p <br />// �L{'Y 1'"T.e (� �z`I'lJ <br />SIGN RE OF CONT R ACTOR OR AUTII. AGENT DATE <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />.URINALS <br />WATER CLOSETS <br />1 <br />WATER HEATERS - ELECTRIC <br />1- <br />WASH BASINS <br />LAUNDRY TRAYS <br />1 <br />1 <br />SUB TOTAL <br />1 � <br />PERMIT S <br />TOTAL FEE <br />WATER SERVICE SIZE BLDG, SUPPLY SIZE <br />SIDE YARD SETBACK <br />STRELI SETUACK <br />2p <br />HEAH YARDSETBACK <br />Z o <br />I'LAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE Z <br />LOT AREA <br />_ <br />VACAN SITE <br />YES ]NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />_ <br />OCCUPANCY GROUT' <br />NO. OF DWL LLING <br />UNITS <br />1 <br />BUILDING <br />S >` <br />I ` <br />I <br />SIZE OF BLDG.( <br />NO. OF STORMS <br />MAX. UCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FRILSP I 1 i NK LCIIS <br />RLVUIIIEED �y <br />❑YES u. rv0 <br />MECHANICAL1 <br />- <br />OTHER <br />1 <br />SPECIAL CONOI TIONS: <br />I <br />PENALTY <br />SEC. 000 WI <br />� <br />_ <br />TOTAL <br />.. I <br />— — <br />--------- <br />P111TAIT VAI.IDAIION <br />WIII N I'l OVI III Y VAI IIIATI I) (IN 1111S SPACE.) Till!; IS YOUR PER <br />, <br />n l'I'l li Alll.11 All ll'111�11Y • 11'IAII'.I IIIII I I I IIY Al l'1111V111111111'i.11A1X111\' <br />C. <br />