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the Evergreen CONSTRU�ICTION everett <br />CITY OF PERMIT <br />everett <br />P CITY HALL 259 8745 • BUILDING - MECHANICAL - PLUMBING <br />EVERETT, WA 98201 COMBINATION <br />OWNER MAIL ADDRESS ZIP PHONE <br />-Lawrenp Barthel_ __ 420A a_ rdStt _Everett _25 -525 <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERALCONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />--EmeXe-tt—BA ; tiers__ _ 5 LW Evergreen Way.Emmett 353� WER1EB-30_ <br />rn <br />-I <br />PH <br />03 <br />m <br />7] <br />MECHANICAL CONTRACTOR MAI ADDRESS PHONE LICENS'-. WO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT CLASS <br />❑COMBINATION <br />®BUILDING ❑PLUMBING []MECHANICAL❑NEW <br />OF WORK <br />�PVV <br />❑ADDITION ❑ALTERATION MREPAIR <br />VALUATION OF WORK <br />s 9995.00 <br />❑ DEMOLISH ❑FENCE ❑SIGN [:)SWIMMING POOL <br />DESCRIBE WORK <br />Re air foundation utters & downspouts. foam siding, windows <br />PROPOSED USE <br />MECHANICAL <br />OF ENERGY <br />[]GAS ❑ELEC. <br />LEGATYPE <br />DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />COPIES) <br />FOVR COPIESI <br />FOUR <br />LOT13LOCKO08 OF Lowell Div. A Plat <br />J� <br />Of Elk. OOB All lot 5 N` Lot 6 <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S I <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 />4208 S. 3rd Ave. <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.V. <br />I <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />T- <br />VENTILATION FAN <br />RANGEHOOD <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />S <br />i <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />DISH WASHERS _ <br />I <br />FAC. BUILT FIREPLACE &CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />GAS. SYSTEM: NO OF OUTLETS <br />FLOOR DRAINS <br />1 <br />SUB TOTAL S <br />1 <br />KITCHEN SINKS 81 DISP. <br />I <br />PERMIT S <br />BAR SINKS <br />ROOF DRAINS - RAIN LEAUER5 <br />TOTAL FEE S <br />I <br />SHOWER BATHS <br />THIS PE RhUT OECJMES NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS. OR IF <br />CONST RUCTION 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 114AVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAME TO OE 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 TI4E PERFORMANCE OF CONSTRUCTION. <br />X / 9 7-1,f <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />1 <br />URINALS <br />WATER CLOSETS <br />I <br />WATER HEATERS - ELECTRIC <br />I <br />WASH BASINS <br />1 <br />LAUNDRY TRAYS <br />1 <br />_ 1 <br />SUB TOTAL <br />PERMIT <br />$ <br />TOTAL FEE <br />21 <br />WATER <br />SERVICE SIP: BLDG. SUPPLY <br />SIZE <br />SIGNATURE OFC N7 ACTOROR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YAROSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACl.NT SITE <br />[]YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CO NET. <br />OCCUPANCY GROUP <br />UNITS OF DWELLING <br />1 <br />BUILDING <br />$9995. 00 <br />52 I OO <br />SIZE OF BLDG. <br />NO. OF STORIES <br />WAX.00C. LOAD <br />PLUMBING <br />I <br />FIfiE ZONE <br />BASEME T <br />FIRE IRED LERS <br />REQUIRED <br />❑YES ❑NO <br />MECHANICAL <br />1 <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />PENALTY <br />SEC. 3031.) <br />TOTAL <br />52 100 <br />-" <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN Yj Ij%Sj ACEl S11591.(Dlo BLitl <br />YOUR REOEIW <br />THANK YOUCD <br />APPLY 710NACCI:PILOBY <br />PLANStnIfCRONY. <br />APPPOVI01oil iS5IlANLLOY <br />ADDRESS FILE _ _. 19,E 1-0 <br />