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Me £ver6rcrn <br />CITY OF <br />everett <br />CITY MALL 2548715 <br />EVERETT. WA 9B]Ot <br />'i •GONSTRUCTIOr <br />PERMIT <br />❑ COMBINATION I� BUILDIN(i ❑ MECHANICAL <br />PE•T NO. 1��19 <br />I� PLUMBINO <br />ONNER MI11L �DDRE55 CITY ZIP PRpNE <br />Kieth Gray 4322 Rucker 98203 252-3668 <br />•RCNITEGT OR DESIGNEP M�IL �DORE55 CITY ZIP PMONE <br />GENER�LCC�ITR�CTOR MAILADDRESS CITY 21P PMONE 4CENSEI <br />Jim i.fannina and Assoc 9003 220th Street S W. Edmonds 98020 774-1964 <br />MECN�NIC�L CUNTHAGT p MAIL ROOflESS dTY 21P PMONE UCENSE � <br />FWMBINO CANTRACTOX MAIL AppRE55 CITY 21P PNONE LICENSE I <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DENOLITION ❑ FENCE K.A SIGN ❑ WOOD STOVfIFIREPLACE INSERT <br />V�1.U�TIpN OF WORK <br />150�.�� <br />DESCRIBE WORK <br />Install and Maintain illuminated Sign <br />LOT_BlOC1t_OF <br />4322 Rucker <br />PLUMEINO <br />TVPE OF FIXTURE OR <br />WATER CLOSET �TOILET) <br />BATHTUB <br />LAVATORY (WASM BASIN) <br />SHOWER <br />KITCMEN SINK d DISP. <br />LAUNDRYTFAY <br />URINRL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETQ) <br />SUB TOTAL <br />PENMIi <br />TOTAL FEE <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILOING PLANS <br />J. FIRE MYDRANT <br />1. fIRE PROTECTION SYSTEM <br />5. GRRDING <br />S7A7EMENT <br />B. HEALTM DISTRICT <br />APPLICATION ACC. <br />OR ATTACH FOUR COPIES� <br />f <br />f <br />S <br />I H�:REBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED YJITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT f'RESUME TO GIVE AUTHORITY TO VIpLATE <br />OR CANCEL THE PFlOVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. <br />SIQRII(URE OF CONiRACTOR OR AUTMOR12ED AGENt DRTE <br />TYPE OF EOUIPMENT <br />AIR COND. UNITS — M P. EA. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT MEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLO7HES DfiVERS <br />VENTILATION fAN <br />RANGEHOOD <br />AIR HANULING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />VARD SETBACK �PLAN CMECK NUMBER <br />VACANT SIiE <br />YES NO <br />NO. OF DWELLIN� <br />MAX. OCQ LOA� <br />FIRE SPRINKLEF: <br />REOUIRED <br />YES . NO <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHEF <br />PENALTY <br />TOTAL <br />SUB TOTAL f <br />PEpM1T f <br />TO7AL FEE f <br />PLAN C <br />FEE <br />VALUATION <br />S 1500.00 <br />U.B.C. <br />SEC. 303 lal <br />FEE <br />RECEIPT NO. <br />FEE <br />WHEN PROPERLY VALIDATED QN THIS SIPA�C?) TMIS iS YOUF�P�R�QIT— Q] <br />: �� '+�09 U � <br />0 <br />� <br />, : r; :,:, r i �: r.- � <br />. . ..�� � �I LiU <br />� �j I i_3 o u <br />ADDRESS FILE <br />