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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 />COM3INATION • BUILDING • MECHANICAL • PLUMBING <br />eve re11 <br />eJ <br />OWNER MAIL ADDRESS ZIP 1•11ONL <br />BILLY BAKM 2022 VIMnM 98201 252-1675 <br />m <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />PERMIT CLASS OF WORK <br />❑COMBINATION <br />[BUILDING ❑PLUMBING ❑MECHANICAL <br />❑NEW <br />PHONE I -ICE NSE NO. <br />PHONE I ICENSE NO. <br />PHONE IiCENSENO <br />❑ADDITION ❑ALTERATION MIx AIR <br />z <br />C <br />W' <br />m <br />VALUATION OF WORK <br />§ 500.00 ❑DEMOLISH <br />DESCRIBE WORK <br />OCNIP PDWnG TO M=C ROOF <br />❑FENCE ❑SIGN ❑SWIMMING POOL <br />- - - <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />9015-416-013-0008 <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-H.P. EA. <br />BOILERS--H.P. EA. <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />1 <br />JOB ADDRESS <br />2027 VIMEM <br />SPACE d WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.U. <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAN <br />RANGEH000 <br />1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />$ <br />_ <br />— <br />1 <br />CLOTHES WASHER <br />I <br />DISH WASHERS <br />I <br />_ <br />WATER HEATER <br />DRINKING FOUNTAINSI <br />FAC. BUILT FIREPLACE d CHIMNEY <br />FLOOR DRAINS <br />I <br />GAS. SYSTEM: NO OP OU7 LET$ <br />KITCHEN SINKS d DIS . <br />SUB TOTAL S <br />BAR SINKS <br />_ PERMIT § <br />ROOF DRAINS - RAIN LEADERS <br />TOTAL FEE g <br />1 <br />SHOWER BATHS <br />_ <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 TI/AT 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 AUT14ORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />X <br />—17-78 <br />SERVICE SINKS <br />SL MPS - SEWAGE PUMP <br />URINALS <br />WATER CLOSETS <br />WATER HEATERS - ELECTRIC <br />- I <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />I <br />SUR TOTAL <br />PERMIT S <br />TOTALFEE <br />WATER <br />SERVICE SIZE BLDG. <br />SUPPLY <br />S1ZE <br />SIG nrVpco R croR OR Au711. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />BUILDING500 <br />§ <br />go <br />1 <br />PLUMBING <br />I <br />FIRE —ZONE <br />BASEMENT <br />FIRESPFRNKLERS <br />REOUIREDEO <br />REOUI <br />❑YES ONO <br />MECHANICAL <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />1 <br />1 <br />- <br />PENALTY <br />SEC. 3031.) <br />1 <br />_ 1 <br />I <br />TOTAL i <br />PERMIT VALIDATION <br />WHENPROPFRIYVAIIDATEDUIQNftPACL$r#IOQ'fyQUiFiiw,II <br />YOURRECEIPT <br />THANK YOU <br />a <br />^I�'IIU11pN pg[ppllp 8, <br />vI PH olfuMLUbY <br />OPPO()VI01014 l!rllANU eV <br />Tic! <br />ADDRESS FILL' 17 it 71 <br />