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rlrr Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 B]A!, <br />EVERETT. WA 9B201 <br />CONSTRUCTION <br />` PERMIT <br />COMBINATION • BUILDING • MECHANICAL a PLUMBING <br />everett <br />�e <br />OWNER MAIL ADDRESS :'n' PHONE <br />Alba Palmer 1626 Rainer 252-6638 <br />m <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />3 <br />-i <br />GEi+IF+iAi_CONTRACTOR MAIL ADDRESS PHONE LICENSE NO, <br />Man"Gry252-7668 <br />Z <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />3 <br />W <br />p� m <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Q <br />crl <br />PERMIT <br />❑COMBINATION <br />KI BUILDING ❑ PLUMBING ❑ MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />0-) <br />VALUATION OF WORK <br />$ 2,000 <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />Repair fireplace <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT19 & 2-%LOCK 334 OF Plat of Everett Div. RJR <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />$ 1 <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 />162G Rainier <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.U. <br />1 <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAN <br />RANGE HOOD <br />1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />S <br />CLOTHES WASHER' <br />WATER HEATER <br />DISH WASHERS <br />1 <br />FAC. BUILT FIREPLACE & CHIMNEY <br />1 <br />DRINKING FOUNTAINS <br />1 <br />FLOOR DRAINS <br />1 <br />GAS. SYSTEM: NO OP OUTLETS <br />KITCHEN SINKS & DISP. <br />I <br />SUBTOTAL S <br />1 <br />BAR SINKS <br />1 <br />PERMIT 5 <br />ROOF DRAINS - RAIN LEADERS <br />1 <br />TOTAL FEE S <br />I <br />SHOWER BATHS <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 I HAVE READ AND EXAMINED THIS APWATER <br />PRIVATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />THIS TYPE <br />PROVISIONS OF LAWS AND ORDINANCES HER SPECIFIED <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />I <br />GVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />X \J $ 18 79 <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />1 <br />WATER CLOSETS <br />1 <br />HEATERS - ELECTRIC <br />1 <br />WASH BASINS <br />1 <br />LAUNDRY TRAYS <br />I <br />1 <br />SUB TOTAL <br />PERMIT <br />$ <br />OTAL FEE <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />sG TA1REo N IRACTO RORAUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PVAN CHEC14 NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP NO. <br />UNITS <br />OF DWELLING <br />I <br />BUILDING <br />$ 2,000.00 <br />20.100 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />I <br />I <br />FIRE ZONE <br />BASEMENT FIRESPRINKLERS <br />REQUIRED <br />OYES ONO <br />MECHANICAL <br />I <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />PENALTY <br />SEC. 303(a) <br />I <br />TOTAL <br />I <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN TII ISSPACEI T14I515 VLTUR PERMIT <br />YOUR RECEIP ) <br />THANK YOU uI <br />-� <br />Q 16 ur 19. <br />— <br />APPLICATION ACCEPRO BY: <br />PLANSUIECKLD BY: APPROVED <br />FOR 14. ANCE BY <br />ADDRESS FII.E '' <br />1 <br />