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UU:'tiC:: I(Lii. l iUIV <br />PL=MIT APPLICATION <br />4141 7" <br />COMBINATION • BUILDING . MECHANICAL • PLUMBING <br />)W NLµ MAIL AUUI/L]>S ZIP 1'I4UNL <br />Harry L. March 17-148th Ave. S.E., Bellevue, WA 98007 747-3200 <br />- <br />ntic MITECF UII ULSIONLR MAILADDRLS$ PHONE 259-2118LICLNSE NU <br />Wight-Hardt & McDuffy 617 Medical -Dental Bldg., Everett <br />GCNLRAL CON TRACTOR MAILAUURC55 PHONE LICENSE NU. <br />MECHANICAL CONTRACTOR MAIL ADORLSS PHONE LICENSE NO. <br />'CUM UINGCONT.II,LC TO R MAILADURESS PHONE LICENSE NU. <br />EnNRi <br />CLASS OF WURK ' <br />❑COMBINATION <br />M BUILDING ❑ PLUMBING ❑ MLCIIANICAL <br />NEW ❑ADDITION ❑ALTEFtAfItIN ❑IILI'Alll <br />!ALUATION OF YJOnK <br />- --- <br />❑DEMOLISH ❑FENCE ❑SIGN ❑-AVIMMINO POOL <br />$ 9S OOO <br />—ESA gi Fil�CTl-6IJ e9r- t��fr �tTiG?�1 G_.t<I_l1 <br />WOPOSED USE <br />OTH ER PERMITS OR APPROVALS <br />ZI REZONE .SPECIAL USE <br />+-r VARIANCE SF:ORLINE <br />_ <br />EGAL OLSC RIPiION Of YRO PE RT\' ISHOLV BELOW OR ATTACH <br />OUR COPIE51 <br />A ptn. of the SA of <br />BLOCK <br />{-+• <br />.OT —OF <br />SEPA CHECK LIST REQUIRED <br />Sec 12, Twp. 28 N, Rge. 4 E,WM, <br />1:t YES <br />L� NO <br />lying NEly of Hardeson Road. <br />78 ADDRESS 770/ <br />S91 Hardeson Road <br />' MECHANICAL - BY OTHERS <br />LUM13ING <br />- BY OTHERS <br />iYoYEf <br />ENEHGv <br />❑FLEC. _ <br />TYPE OF_COUIPMENT _ _ -I FEE <br />AIR CONO.UNITS- H.P. EA. _•_S 1 _ <br />RLF RICE RnTInN VNtfS 1!Y, EA. - --� <br />BORERS H.P. EA.---•--------�•�I�-T <br />Fp. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />HAI Il I <br />S 0 <br />CI OI11E51'A\SLIER <br />I <br />� <br />RD A PUGEIR $Y $T EIAS IL T. V. ME A. _• L-�- <br />SPACE L WALL HEATERS - B.T.U. --�-- <br />UISHLYASHEII$ <br />DIIINCIN:i FOUNTAINS <br />EI OOR DIIAINS <br />I1� <br />---- '-- <br />UNIT HEATERS 4.7.U. <br />—�-� <br />SINKS P DIftY <br />__KI[UIIFN _ <br />ItAII SINKS <br />Y� <br />I <br />_- <br />EVAPORATIVE COOLERS _-_-.•-_-___ <br />CLOTHES DnVE nS <br />L-_- <br />IIOOE OH nll.S RniN lE.'11iEit5 <br />�I__ <br />. <br />SHOC1ER RA7115 <br />VENTILA110NTAN <br />SERVICE SINKS <br />RANGE HOOD _ <br />�__ �-1 <br />BDFi YS -SEL'1A(iE PUMP <br />AIR HANDLING UNIT <br />I - <br />UFtINALS <br />/.I U <br />__ <br />__.._---_-.._ .. ._._ ._-.-..1--..-__ <br />WA IE11 CL OSCTS <br />_._ ------ <br />- <br />-WATER HEATER_, <br />- -_ <br />U <br />WATE It 11F:ATEIIS - ELE CI RIC <br />---s- <br />/ <br />------- <br />FnC.-DUILT FIREPLACL h CH11ANEY <br />.. -_ �- <br />------- _ <br />WASH BASINS <br />,U <br />- _ <br />.. ____ _ -_ _... ...--....._ <br />GAS. SY STEM _NO OP OV Rf 15 <br />- ....Sun <br />._.- 4 <br />LAUNDRY TRAYS <br />) <br />TUTAC, <br />3% <br />70TAL f EE <br />sunTOTni <br />- - AND - - <br />71115 PL I1!.11T UCCONIFS NV1�1. ANn VOID II 1Y(I11K ITH CU NSTR VC <br />TIDN AUT11(IfRIED IS Ii01 C(1:,6ILNCJD WITIIIN 110 UAYC, 0.11 If <br />CUNF;lRkiCTION OR WORK CI SU::L 1'ND C[/ Oil nf1ANDO NEO E01i n <br />PeFitoD Ot 120 DAYS AT ANY IIMI Ai TCR WOTIK I:i CONILLE.NCLD. <br />PEllh11T S <br />_ <br />% <br />T_O_TAL FEE f <br />- <br />TER SERVICE SIZE BLDG. SUPPLY SIZE <br />-- <br />I tanE11Y OEnTIFY THAI I DAVL READ AND EXAMINtn THI:: A^ <br />PLICATRIN. AND KNOW TILL SAME TU RL TFRIC AND COIIIII Cl. ALL <br />,. t x1UACN <br />'TILL S-IUA('K <br />BLAR 1'ARUSLIUACI• <br />PnnVlfi:ONS OF LA1`:S AND ORDINANCES GOVERNING 1141$ TYPE <br />- <br />_ <br />OF WORK WILL BE CO'.IPLIEO WITH WI1ET µEll SP(CtFILO HEFiEl% <br />OF A PERMITt NOT PftCSL1,.1E TO <br />VACANT SITE <br />L ZONE <br />' ^� <br />7� <br />L07 ARIA <br />On NOl• TIIF GRAN7ING OGOES <br />GIVE AUT110ft1TY TO VIOLAfOIl CANLL TILE PROV1510NS OF <br />F CONST RUCTION <br />- <br />K <br />YES ONO <br />ANY OnrtR SI ATE Oil LOCAL LAZY µLGULATINU <br />1 011 711C 1'ETiF OIIALA NCE OF CD NST NVCTION <br />` <br />:PE Of CONST. <br />UC CUPANCY' GITOUI' <br />NO.Of DWELLING <br />UNITS / <br />�� - <br />ZE OF BLDG, <br />F10.0F STORIES <br />MAX. OCC. LOAD <br />ISIGN&,C& <br />CUN i CIC 1011 AUT11. AIiEN�n1/C <br />'IL ZONE <br />' <br />ILA' M.LM.L NT <br />..m�-+.A�^�•^'�TM"�"�^� <br />i'y-,.0 - 1'a AN CIIL LK I LL <br />L11LLN NUMJUi <br />IIIR .'.I•(i1NK Ll11.S <br />FILOUID1. I/ -' <br />BI'' <br />❑YES Fju•O <br />>/ RECEIPT NO. <br />/lT i i pd/3J <br />FEES VALUATION FFF, <br />LCIAC CONDITIONS: <br />�7J� �it.-�-✓ii%i% <br />BUILDING s`�LJa%�V. Ll% ,�) 77 10( <br />prLl'LIBI"tF _ y ✓J (��(> <br />APA REVIEW COMPLETE: OYES ❑NO <br />�+ <br />COn10C1 Plennlnq dapf. <br />1.1LC11ANICAL I__.. ... <br />_ <br />I <br />cnrcn J 1-•- <br />.•CNALTY <br />5[C. JDJ Id <br />1 <br />_ <br />. 4lIK1N KUIIIU �♦ <br />.anwa.11uw•r <br />._ <br />.VrIKIVInro...NVZ I_v <br />Aril <br />i <br />