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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 <br />Co"ISTRUCTION <br />PERMIT <br />❑ COMBINATION BUILDING ❑ MECHANICAL <br />PERMIT NO. 07966 <br />❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Component Concepts 3619 Pine Street <br />ARCHITECT OF DESIGNER MAIL ADDRESS CITY ZIP PHnNF <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE# <br />Simco Sign Corp. 2719 Maple <br />Everett <br />98201 <br />252-0086 <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CRY <br />IF <br />PHONE LICENSE <br />PLUMING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE XHSIGN ❑GARAGE <br />$ 500.00 <br />erect non -illuminated sign <br />PROPOSED USE OF BUILDING <br />commercial <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 />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 THE PERFORMANCE OF CONSTRUCTION, <br />SIGNATURE OF OR AUTHORIZED AGENT DATE <br />X 7/21/80 <br />LEGAL DESCRIPTION OFPROPERTY (SHOWBELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK —OF <br />JOB ADDR SSA <br />,-3619 Pine Street <br />PLUMBING <br />ME04ANICAL <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 8 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS — B.T.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 />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL 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 />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S 500. <br />5 <br />00_ <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE <br />REQUIRED <br />OYES <br />SPRINKLERS <br />ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />_ <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303(a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />5 <br />00 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />51 1 7 S 0 0 5.0 0 <br />CT) <br />Imo.. <br />YOUR RECEIPT::' <br />THANK YOU <br />B. GRADING <br />B. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />