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i the Evergreen <br />,I <br />CITY OF <br />9 everett <br />CITY HALL 2598745 <br />EVERETT. WA 98201 <br />CONSTRUCTION <br />PERMIT <br />COMBI IATION • BUILDING • MECHANICAL • PLUMBING <br />OWNER MAIL ADDRESS LIP PHONE <br />J. R. Voetberg 3413 Rockefeller <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />.D <br />R1 <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />z <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Natural Gas Equipment <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />m <br />j 'A <br />PERMIT CLASS <br />❑COMBINATION <br />❑ BUILDING ❑ PLUMBING ❑ MECHANICAL <br />OF WORK <br />❑NEW El ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />S <br />❑DEMOLISN ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />Conversion Burner <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 />LOT BLOCK —OF -- <br />_ <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 />I <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />io u ner 200 000 <br />5 00 <br />Job ADL LESS <br />413 Rockefeller <br />SPACE &WALL HEATERS -B.T.U. <br />UNIT HEATERS-B.T.U. <br />1 <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAN <br />RANGE HOOD <br />� <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />- <br />BATH TUBS <br />5 <br />I <br />— ___ <br />—�— <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />I <br />DISH WASHERS <br />I <br />FAC. BUILT FIREPLACE &CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />I <br />GAS. SYSTEM: NO OP OUTLETS <br />FLOOR DRAINS <br />1 <br />SUBTOTAL 5 <br />��g <br />N <br />KITCHEN SINKS & DISP. <br />I <br />PERMIT 5 <br />TOTAL FEE S 8 AO <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONST RUC <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 />1 ISCERTIFY 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 CONPTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />- <br />X -QJ_i ..- - Z,� GOn .�w�-11118/72 <br />BAR SINKS <br />ROOF DRAINS - RAIN LEADERS <br />SHOWER BATHS <br />' <br />I <br />SERVICE SINKS <br />SUMPS -SEWAGE PUMP <br />URINALS <br />WATER CLOSETS <br />I <br />WATER HEATERS - ELECTRIC <br />1 <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />1 <br />T <br />SUB TDTAL <br />PERMIT <br />5 <br />TOTAL FEE <br />WATERSERVICESIZE <br />BLDG. SUPPLY <br />SIZE <br />SIGNATURE OF CONTRA TOROR AUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YAROSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑"ES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITOS DWELLING <br />I <br />BUILDING <br />5 <br />1 <br />SIZE OF BLDG. <br />NO. OF STRIES <br />O <br />MAX. OCC. LOAD <br />PLUMBING <br />1 <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES ONO <br />MECHANICAL <br />' 00 <br />1 <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />PENALTY <br />SEC. 003(41 <br />TOTAL <br />I <br />8100 <br />— <br />--- <br />PERMIT VALIDATION <br />WHEN PROPS RLY VAL GAT ED(13 II[:R:I .AC<�•T�i� � RP�ERRM1T� <br />JV 1 L <br />YOUR RECEtP1P, <br />THANK YOII r♦, <br />li 1 n • ! ! <br />— <br />APPLICATION ACCEPILU OY: <br />_ <br />PLAN UILCKLUKr. <br />FAPPII­OV10-10"7�5JAWSIIY. <br />,ADDIIESS FILL- I I� ctrT I, I <br />