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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259.8745 <br />EVERETT, WA 98201 <br />CONSTRUCTION everett <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />OWNER MAIL ADDRESS LIP I'Hi. 'Ni <br />Maralyn Haglund G25 33rd Street <br />_- <br />ARCHITECT DR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />m <br />7J <br />-'i <br />z <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Natural Gas Equipment Co. <br />9 <br />m <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO, <br />PERMIT <br />❑ COMBINATION <br />❑BUILDING ❑PLUMBING [RXECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />$ <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />NO. <br />TYPED <br />FEE _ <br />AIR COND. UNITS-H.P.H.P. EA. EA. <br />$ I <br />REFRIGERATION UNITS-H.P. EA. <br />__ <br />BOILERS-H.P. EA. <br />I <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />JOB ADDRESS <br />625 33rd Street <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATEIiS-B.T.U. <br />T <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAP.1 <br />RANGE HOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M.- <br />BATH TUBS <br />CLOTHES WASHER <br />5 <br />I <br />_ <br />WATER HEATER <br />I <br />�00 <br />DISH WASHERS <br />1 <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />I <br />GAS. SYSTEM: NO OF OUTLETS <br />FLOOR DRAINS <br />I <br />SEIB TOTAL $ <br />2 IDO <br />KITCHEN SINKS & DISP. <br />1 <br />BAR SINKS <br />I <br />PERMIT SDO <br />ROOF DRAINS - RAIN LEADERS <br />I <br />TOTAL FEE S <br />I <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 />CONSTRUCTION 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 THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />1/27/79 <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />1 <br />WATER CLOSETS <br />1 <br />WATER HEATERS - ELECTRIC <br />1 <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />I <br />SUB TOTAL <br />PERMIT S <br />TOTAL FEE SX <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />SIGNATURE OF CONTFRACTORORAUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO.OF DWELLING <br />UNITS <br />I <br />BUILDING <br />$ <br />1 <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />VAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE. <br />BASEMENT <br />FIRE SPRINKLERS <br />R D DYES ONO <br />YES <br />MECHANICAL <br />S 1 00 <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />I <br />PENALTY <br />SEC. 303(u) <br />_ -------- T <br />I <br />TOTAL <br />S 100 <br />- -- <br />PERMIT VALIDATION All/I1 <br />WHEN PROPF RI Y "At (DATED IIN THIS SPAD ' 1 .} I PE, RMT <br />XO.0 R REC;E1 <br />TH N xau <br />� � � 00 <br />APPLICATION ACCEPTED BY <br />PLANS t'AIFCNfB BY <br />APPROVED FOR ISSUANCE By <br />I. <br />