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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 <br />CONSTRUCTION <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL • PLU.eBING <br />D <br />n.u�.avun rsa ZIP PHONE <br />Irene C. Mielsen 2110 Rainier Avenue 98201 259-5384 <br />m <br />M <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE - LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Natural Gas Equipment Co., Inc. 1611 East Grand 258-2441 <br />Z <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />9 <br />W <br />In <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />❑COMBINATION <br />❑ BUILDING ❑ PLUMBING ®xUECHANICAL <br />CLASS OF WORK <br />❑NEW ❑gODIT10N ❑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 COPIES) <br />LOT BLOCK —OF <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S I <br />REFRIGERATION UNITS-HY. EA. <br />—_ <br />BOILERS-H.P. EA. <br />EA. <br />I <br />FORCED Al" SYSTEMS-B.T.U. MEA. <br />JOB AD <br />2110 Rainier Avenue <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 />RANGE HOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM _ <br />BATH TU85 <br />_ FEE <br />S <br />AIR HANDLING UNIT- C.F.M. <br />CLOTHES WASHER <br />1—RangeI <br />DISH WASHERS -- <br />1 <br />WATER HEATER <br />DRINKING FOUNTAINS <br />I <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />FLOOR DRAINS <br />I <br />GAS. SYSTEM: NO OP OUTLETS <br />KITCHEN SINKS & DISP. <br />I <br />SUB TOTAL S <br />3 IOU <br />BAR SINKS <br />1 <br />PERMIT S <br />AINS - RAIN LEADERS <br />ATHS <br />1 <br />TOTAL FEE S 6 I0f1 <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONS)0INKS TRUC <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 1 HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TIIIS 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 />x Check #8094 11/27/78 <br />FSHOWER <br />EWAGE PUMP <br />1 — <br />OSETS <br />I <br />EATERS - ELECTRIC <br />I <br />INS <br />I <br />LAUNDRY TRAYS <br />SUB TOTAL <br />PERMIT <br />S <br />TOTAL FEE <br />1 <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />—ZONE <br />STREETSETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE <br />LOT AREA <br />VACANT SITE <br />❑vE5 ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITS <br />NO.OF DWELLING <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />BUILDING <br />$ <br />I_ <br />PLUMBING <br />I <br />FIRE ZONE <br />BASEMENT FIRESPRINKLERS <br />REQUIRED <br />❑YES ❑NO <br />MECHANICAL <br />6 1 OO <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />I <br />PENALTY <br />SEC. 303(a) <br />I <br />TOTAL <br />6 j 00, <br />PERMIT VALIDATION <br />WIII.N PRUPT RLY VAI IDAI ED IIN T11IhS ACE1 1 S b'1 U PL HMI IA <br />YOU R REC` 1P,'f <br />Tf•IA4 YOU, <br />` <br />97ww72 <br />APpnf.NION ACCEPTED BY: <br />PLANS 1:11[CKLU BY ' APPROVID <br />FOR ISSUANCE BY <br />„DURESS FILL ,N— <br />