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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259824S <br />EVERETT. WA 98201 <br />CONSTRUCTION wcrett <br />PERMIT <br />COMBINATION - BUILDING - MECHANICAL - PLUMBING .e <br />OWNER MAIL ADDRESS PHONE <br />TIRE SALES & SERVICE <br />ARCHITECT OR DESIGNER MAIL gODRE55 PHONE - IJ CENSE NO <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />TUBE ART DCSPLAYS, I:lc. 1-Boo-562-2854 <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT CLASS OF WORK <br />❑COMBINATION <br />® BUILDING []PLUMBING []MECHANICAL <br />❑NEW [I ADDITION ❑ALTERAIIUN ❑REPAIR <br />IT! <br />7 <br />c <br />3 <br />Do <br />m <br />:0 <br />VALUATION OF WORK <br />S 3000-00 <br />❑DEMOLISH ❑FENCE CRSIGN ❑SWIMMING POOL <br />DESCRIBE WORK - <br />ERECT POLE I -?BUNTED S GN <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 EOUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />_ <br />$ I <br />REFRIGERATION UNITS-H.P. EA <br />A. <br />EA. <br />I <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />JOB ADDRESS <br />27G1 l'7AI�tIUT <br />_ <br />SPACE & WALL HEATERS - B.T.U. <br />--1- <br />UNIT HEATERS-B.T.U. <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />$ <br />I <br />CLOTHES WASHER <br />! <br />WATER HEATER <br />DISH WASHERS <br />I <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 />SUBTOTAL $ <br />BAR SINKS <br />I <br />PERMIT $ <br />ROOF DRAINS - RAIN LEADERS <br />I <br />TOTAL FEE $ <br />1 <br />SHOWER BATHS <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCI ION 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 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 T14E PROVISIONS OF <br />ANY OT14ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />// <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />WATER CLOSETS <br />I <br />WATER HEATERS - ELECTRIC <br />I <br />WASH BASINS <br />I I <br />LAUNDRY TRAYS <br />SUB TOTAL <br />PERMIT <br />S <br />TOTAL FEE <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />SIGNATURE,�, <br />CONTRACTOR ORn TH. AGENT DATE/77 <br />SIDE YARD SETBACK <br />STREETSETBACK <br />REAR YARD SETBACK <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 />UNITS <br />NO. OF DWELLING <br />I <br />BUILDING <br />$ 3000.00 <br />1 1 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />I <br />I <br />1 <br />FIRE ZONE <br />BASEMENT FIRESPRINKLERS <br />REQUIRED <br />OYES ❑NO <br />MECHANICAL <br />SPECIAL CONDITIONS: <br />OTHER <br />PENALTY <br />SEC. 000(.1 <br />I <br />TOTAL <br />1 00 <br />PERMIT VALIDATION <br />IIN711% AC( ISVIIiV QRi}I Pt It'.tll <br />WHEN PROPS RI. Y VAT IOAT ED 7 <br />YOURRECEIPT <br />THANK YOU <br />0 <br />FLICATIONACCtF11,08Y <br />PLANSOfICKEN BY. <br />YI IIlOIi ISSUnNCf BY <br />rk.c./iTb/lc <br />ADDRESS FILL - 7 hui 77 <br />