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the Evergreen CONSTRUCTION <br />CITY OF PERMIT <br />ever ent <br />CITY HALL 259.8745 <br />EVERETT, WA 98201 COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />everett <br />,,ei <br />OWNER MAIL ADDRESS ZIP P11"NI, <br />Irene Neilsen 2110 Rainier <br />m <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERALCONTRACTOR - MAIL ADDRESS PHONE LICENSE NO. <br />Z <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Natural Gas Equipmentcyl <br />3 <br />m <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />co 70 <br />00 <br />PERMIT <br />❑ COMBINATION <br />❑ BUILDING ❑ PLUMBING []MECHANICAL <br />CLASS OF WORK <br />[]NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />S <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK '- <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIESI <br />LOT BLOCK —OF <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S I <br />REFRIGERATION UNITS-H.P. EA. <br />1 <br />- <br />JOB ADDRESS <br />2110 Rainier <br />BOILERS-H.P. EA. <br />I <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.U. <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />1 <br />RANGE HOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />—� <br />BATH TUBS <br />$ <br />-' <br />1 <br />CLOTHES WASHER <br />1 <br />], <br />WATER HEATER2 <br />no <br />DISH WASHERS <br />1 <br />DRINKING FOUNTAINS <br />1 <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />FLOOR DRAINS <br />1 <br />GAS. SYSTEM: NO OP OUTLETS <br />KITCHEN SINKS & DISP. <br />1 <br />SUB TOTAL $ <br />100 <br />BAR SINKS <br />1 <br />PERMIT 5 <br />3 <br />HOOF DRAINS - RAIN LEADERS <br />TOTAL FEE SI <br />rI <br />SHOWER BATHS <br />00 <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 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 />xe dg� ggQ 5/4/79 <br />a E/ <br />—SIGNATURECOTI Ri ACTORE�W AUTH. AGENT DATE <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />I <br />WATER CLOSETS <br />WATER HEATERS -ELECTRIC <br />I <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />1 <br />1 <br />SUBTOTAL <br />PERMIT <br />5 <br />TOTAL FEE <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />SIDE YARD SETBACK <br />STREETSETBACK <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 []NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP NO. <br />UNITS <br />OF DWELLING <br />I <br />BUILDING <br />$ <br />I <br />S1ZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />1 <br />f- <br />-IRE ZONE <br />BASEMENT REOUI <br />REO <br />ED <br />YES ONO LERS <br />OYES <br />MECHANICAL <br />5 IGQ <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />I <br />PENALTY <br />TOTAL <br />SEC. 0091.) <br />1 <br />5 100 <br />PERMIT VALIDATIONL WIB N PROPERY VAI IDATED IIN 111IF SPACL) I IUS IS •YOUR PERMIT <br />YOUR RECEIW <br />THANK Y.OU0000 <br />4 our .79. <br />ARLICATIONACCEPTEOKY: <br />YLANSC14ICKEDBY: APPgOVERfOR1WJAhla <br />Hv <br />ADDRESS FILE <br />