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the Evergreen <br />CITY OF <br />everett <br />259-8745 <br />C-INSTRUCTION <br />PERMIT <br />PERMIT NQ: _ 1 6 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING n SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Roebling Management 1402 SE Everett Mall Way Everett, WA 98204 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Heath Northwest 11805 NE 116th Kirkland, WA 98034 623-3100 REATH330RI <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE - LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />CLASS OF WORK <br />52 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR Ll PEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />$ 18,000. <br />DESCRIBE WORK <br />Install 6 maintain D/F 10'6" x 14'2" sign installed on Everett Mall Sign (illuminated) <br />HEAT SOURCE <br />Cl ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />shopping mall identification <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIG NATU E OF .OIITPACTOR. AUTHORIZED AGENT 0 WRIER DATE <br />X/(//� <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT ___ BLOCK _ OF <br />JOB ADDRESS <br />1402 SE Everett Mall Way <br />PLUMBING <br />MECHANIC <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNOLG UNITS - H.P. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS - H P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS - B.T.U./H.P. <br />SHOWER <br />GAS FIRED A.C. UNITS-B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA, <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC.) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />$ <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTALFEE <br />S <br />TOTALFEE <br />,7 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />V UATIUN <br />FEE <br />BUILDING <br />$18,000. <br />57 <br />OO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />Sl—OOF BLDG. <br />NO OF STORIES <br />MAX. OCC. LOAD <br />MECHANICAL <br />-.IVI .A 11�1 <br />VVV�(livai <br />FIRE SPRINKLERS REOUIRED ❑ YES D NO <br />INVESTIGATION FEE <br />HUBeaa�1H)I <br />STATE BUILDING SURCHARGE <br />fl00007'119 «V <br />STATE ENERGY SURCHARGE <br />ELEC $311.00 <br />APPLICATION ACC. BY <br />PUNS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />L.N. Callahan <br />9/5/87 <br />DRIVEWAY PERMIT <br />_ <br />TOTAL <br />57 <br />00 <br />ReomT' "el manna <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />V— <br />co <br />L`- <br />00 <br />R— <br />M <br />A[ TRESS FILE <br />