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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 <br />^.ONSTRUCTION <br />PERMIT <br />❑ COMBINATION PBUILDING ❑ MECHANICAL <br />PERMIT NO. 09415 <br />❑ PLUMBING, <br />OWNER <br />Flame Tavern <br />MAIL ApDRE55 <br />4202 Rucker <br />CNT <br />`II' <br />PN°NE <br />Everett <br />98203 <br />AgCHRELi OR pESIGNER <br />MAIL ADDRESS <br />CITT <br />ZIP <br />PIIONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />Simco Sign Corp <br />2719 Maple <br />P <br />CITY <br />Everett <br />TP <br />98206 <br />PHONE ucENSE1 <br />252-0086 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />'.ONE LICENSE <br />PLUMBING CONTRACTOR <br />SI <br />MC OS C272P3MAIL <br />ApDRE55 <br />CITT <br />ZIP <br />PHONE LICENSE) <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR El DEMOLITION ❑FENCE }f"SIGN ❑GARAGE <br />VALUATION OF WORN <br />s 1400.00 <br />DEscRIeE wonK <br />Erect illuminated Sign <br />rgoPosEp usE of BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ ANDTHIS AP <br />DCORRECT.. <br />LEcaL OtB HimT10N or PROPERTY <br />(SHOW DELOW OR ATTACH FOUR COPIES) <br />PL CATION AND KNOW THE SAME TO BE TRUEAND <br />LOT BLOCK_ -OF <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO. <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTIO OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUR TOR OR AUTHORIZED AGENT DqT <br />JOB ADDRESS <br />4202 Rucker Avenue <br />X 4 3% <br />PLUMBING <br />CHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />TYPE OF EQUIPMENT FEE <br />WATEfl CLOSET (TOILET) <br />UNITS — M.P. EA. <br />BATHTUB <br />. <br />TION UNITS -- H.P. EA <br />LAVATORY (WASH BASIN) <br />11.P. EA. <br />SHOWER <br />KC <br />KITCHEN SINK & DISP. <br />A.C. UNITS — TONNAGE EA. <br />IR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />TERS — B.T.U. M <br />LAUNDRY TRAY <br />ERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT — C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR, ETC) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT f <br />TOTAL FEE <br />S <br />TOTAL <br />FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />_ <br />FEE RECEIPT N0. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />C]YES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />SIZE OF SLOG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />BUILDING <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRE SPRINKLERSREQUIRED <br />MECHANICAL <br />❑YES ❑NO <br />W(a) <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />2. 3UILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />E , ' (, y. / L1 <br />5 GRADING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMP, -,CT STATEMENT <br />T <br />8. HEALTH DISTRICT <br />