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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259074!. <br />EVER ETT, WA 98201 <br />INSTRUCTION 1 <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />e verett <br />�e� <br />VYYIVCR MA11 AI'I1W ::' LIP ... HONE <br />Gerald W. Kwas 5731 153rd Place S.W. Edmonds 98020 793-5891 <br />rn <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />9 <br />1 <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Gerald Const. <br />Z <br />C <br />MECHANICAL CONTRACTOR MAIL AwORESS PHONE LICENSE NO. <br />9 <br />W <br />En <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />N <br />PERMIT <br />El COMBINATION <br />BUILDING ❑PLUMBING []MECHANICAL <br />CLASS OF WORK <br />❑NEW []ADDITION ❑ALTERATION ❑REPAIR <br />(J-1 <br />VALUATION OF WORK <br />S <br />DEMOLISH [FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />Demolish single family residence <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT 22-23 BLOCK 7 OF Fr.ida Is First <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 />_ <br />BOILERS-H.P. EA. <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />JOB ADDRESS <br />3518 Wetmore <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.U. <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGE HOOD <br />1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />_ <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />$ <br />I <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />DISH WASHERS <br />DRINKING FOUNTAINS <br />I <br />FAC. BUILT FIREPLACE b CHIMNEY <br />I <br />FLOOR URAINS <br />GAS. SYSTEM: NO OP OUTLETS — <br />_ <br />KITCHEN <br />KITCHEN SINKS & DISP. <br />1 <br />SUO TOTAL S <br />BAR SINKS <br />PERMIT S <br />ROOF DRAINS - RAIN LEADERS <br />TOTAL FEE S <br />1 <br />I <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 />1 HEREBY CERTIFY THAT 1 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 CAN C E L <br />NCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW IIIUL ATING CONSTRUCTION <br />OR THE PERFORMANCE OF CO NSTRU ION. <br />% i/ / 2/9/79 <br />-x-� <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />WATER CLOSETS <br />I <br />WATER HEATERS —ELECTRIC <br />I <br />WASH BASINS <br />1 <br />LAUNDRY TRAYS <br />SUB TOTAL <br />PERMIT <br />$ <br />TOTAL FEE <br />WATER <br />SERVICE SIZE BLDG. SUPPLY SIZE_ l <br />YGNATURE OF CONTRACTORU-AGENT DATE <br />SIDEYARDSETBACK <br />STREETSETBACK <br />REARYAROSETBACK <br />PEA .HECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP NO. <br />UNITS <br />OF DWELLING <br />BUILDING <br />S <br />DD I OO <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX.00C. LOAD <br />PLUMBING <br />1 <br />FIRE ZONE <br />BASEMENT FIRE <br />REQUIRED <br />SPRINKLERS <br />OYES ONO <br />MECHANICAL <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />1 <br />i <br />PENALTY <br />SEC. 303 IB) <br />I <br />TOTAL <br />00 t 00 <br />O <br />---a'r—s-- <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THISSPACEI THIS IS YOUR PERMIT <br />v, <br />CT) <br />y l <br />B <br />_ <br />MN� <br />Aml" MI�RIP110by <br />1[ —. <br />[LAM0ItCXtbHY: AITROVCO <br />FOfl IWIAMI BY. <br />ADDRESS FILE <br />