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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259.8745 <br />EVERETT, WA 98201 <br />CONSTRUCTION <br />n <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL a PLUMBING <br />OWNER AIL ADDRESS ZIP PHONE <br />R. R. S:aitb xz= 4211 Rucker <br />m <br />D <br />3 <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO, <br />GENERAL CONTRACTOR MAILADDRESS PHONE LICENSE NO. <br />Z <br />C <br />3 <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Gas EquipAent 1611 East Grand <br />m <br />conatural <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT CLASS' <br />[COMBINATION [I BUILDING ❑PLUMBING gMECHANICAL <br />-WORK <br />❑NEW []ADDITION, ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />S <br />[I DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />_ <br />DESCRIBE WORK <br />Fur,lace <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY❑GAS ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACII <br />FOUR COPIES) <br />LOT BLOCK__OF <br />ND. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS—H.P. EA. <br />REFRIGERATION UNITS—PIR. EA. <br />BOILERS—H.P. EA. <br />1 <br />1 <br />FORCED AIR SYSTEMS—B.T.U. MEA. <br />1: OD <br />I <br />JOB ADDRESS <br />4212 RUCIER <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS—B.T.U. <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AI R HANDLING UNIT— C.F.M. <br />BATH TUBS <br />CLOTHES WASHER <br />DISH WASHERS <br />S <br />1 <br />I <br />WATER HEATER <br />VAC. BUILT FIREPLACE &CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />I <br />GAS. SYSTEM: NO OR OUTLETS <br />FLOOR DRAINS <br />1 <br />SUB TOTAL S <br />! I <br />KITCHEN SINKS & DISP. <br />PERMIT S <br />BAR SINKS <br />1 <br />ROOF DRAINS — RAIN LEADERS <br />SHOWER BATHS <br />TOTAL FEE S 1 <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONST RUC <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 HEREOY 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 THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />ON THE PERFORMANCE OF CONSTRUCTION. <br />1�2]/78 <br />X <br />SERVICE S INES <br />SUMPS — SINKS PUMP <br />URINALS <br />WATERCLOSEIS <br />1 <br />WATER HEATERS — ELECTRIC <br />1 <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />- <br />1 <br />I <br />SUB TOTAL <br />PERMIT <br />$ _ <br />]DIAL FEE <br />WATER <br />SERVICE SIZE BLOG. SUPPLY <br />SIZE <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANTSITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UWO OF NITS DWELLING <br />BUILDING <br />$ <br />I <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />1 <br />FIREZONE <br />BASEMENT <br />FIRESPRINKLERS <br />REQUIRED <br />❑YES []NO <br />MECHANICAL <br />% I JD <br />SPECIAL CONDITIONS: <br />OTHER <br />1 <br />I <br />PENALTY -.SEC. <br />303(a) <br />I <br />TOTAL <br />I <br />] I OU <br />— <br />PERMIT VALIDATION U PAC 9 RI'ERM <br />WI/FN PROPERLY VALIDATED <br />THANK YbU <br />r <br />AMLICA71ONACCUPILUEY- <br />PLAN UAL HJBY. <br />APPNIVLO FOR UANCL 9Y <br />eb <br />ADDRESS FILE <br />