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C STRUCTION K -el" <br />PERMIT APPLICATION <br />T. I <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING I <br />OWNER MAIL ADDRESS ZIP r"u Nt <br />David A. Brandvold P.O. Box 3066, Everett, WA 98203 355-1135 <br />ARCHITECT UR DESIGNER MAIL ADDRESS PHONE LICENSE NO <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />David A. Brandvold Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Everareen State Sheet Metal <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO <br />Plumbing ---- - <br />' <br />MIy.'G <br />YERCLASS OF WORK <br />❑COMBINATION <br />.BUILDING []PLUMBING ❑MECHANICAL )M NEW ❑ADDITION ❑ALTE FIA I1 dN ❑HLPAIR <br />VALUATION OF WORK G- <br />D�`J �?'I C�7.G.�-) ❑DEMOLISH ❑FENCE ❑SIGN ❑'11VIMMIN(: POOL <br />S - <br />K <br />DESCRIBE WORK <br />Const•-. ': ?rehouse I <br />PROrO-- TTOTHER PERMITS OR APPROVALS <br />REZONE tj SPECIAL USE <br />LEGAL DESCRIPTION OF PROPE ATV IS HOW BELOW OR ATTACH }.� <br />FOUR COPIES) .VARIANCE 1-i SHORLINE <br />LOT BLOCK_OF <br />SE PA CHECK LIST REQUIRED <br />Legal attached. YES Has been reviewed and received <br />JZJ NO negative declaration. <br />JOB ADO RE55 <br />3 11-5 S 7' MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY - <br />❑r.ns ❑FLee. <br />TYPE_OF_EOUIPMENT.-,_.--__—+.__.,,_ <br />NO. <br />_ <br />AIR COND. UNITS-H.P. EA. <br />REFRIGERATION UNITS H.v. En. ^-_ <br />—------ <br />BOIL Ens H.P. EA.----.�__-__ I _ <br />PURGED Aln SYSTEMS B.T.V. MEA. —T— r <br />------ <br />----L-"—� <br />' , <br />SPACE P, WALL HEATERS B.T.U. •—___L"� <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NAYH Yl1B5 <br />$ <br />CLOTHES WASHER <br />' <br />DISH WASHERS <br />{ <br />'- <br />DRINKING FOUNTAINS <br />I <br />FLOOR DRAINS <br />{ <br />_ <br />UNIT I(EATERS R. TV1 <br />KITCHEN SINKS & DISP. <br />I <br />- ------ <br />EVAPOH/1TIVE COOLERS <br />_ <br />CLOTHES DRYERS <br />T- <br />_ <br />LIAR SINKS <br />I <br />HOOF DRAINS RAIN LEADERS <br />I <br />SHOWER BATHS <br />VENTILATION FAN—�- <br />T <br />SERVICE SINKS <br />RANGE HOOD _ <br />— -- ---- --- <br />AIR HANDLING UNIT C,F.M. <br />__.._...._ . 1 <br />.. ... ...... __._ . .. _... -{-•— <br />WATER HEATER <br />SUMPS -- SEWAGE PUMP <br />URnINAINA LS <br />I <br />_WAY E. H CLOSETS <br />I <br />I <br />WATER HEATERS - ELECTRIC <br />._ <br />FAC. BUILT FIREPLACE & CHIMNEY_ <br />WASH BASINS <br />I <br />_ _ <br />GAS. SYSTEM: NO OF OUTL(.1S T <br />._ 1 <br />. SUO IUML 5' I <br />--- PE nMIT 5 <br />TOTAL FEE 5 I _ <br />IHI!'. Pf. TIMIT BECOMES Nlll l AND VOID II WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COM ILNCCD WITHIN 170 UAY(i. OFT IF <br />CONSTRUCTION On WORK I;: SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 170 DAYS AT ANY TIME Al- TCi(WOFIr, IS COMMENCEU. <br />LAUNDRY TRAYS <br />I <br />_i-_._.- - -_ <br />SUB TOTAL <br />T <br />PERMIT S <br />I <br />_T— <br />_ <br />TOTAL FEE <br />WATER SERVICE SIZE. BLDG. SUPPLY SIZE: <br />THIS <br />1 HEREBY CERTIFY THAT I HAVE HLAO nNO L`(nMINFD A? <br />P LIGATION AND KNOW THE SAME T(1 RE T(:VE AND COlt IIEC T. ALL <br />S- <br />1 ACK <br />HEAR YAH(J SE TtlACK <br />PROVISIONS OF LAWS AND OIIDINANCES GOVERNING 1I11S TYPE) <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN' <br />U::L ZCHJL <br />LOl ARIA <br />—_ <br />VACANT SITE <br />OR NOT. THT GnAN-ING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTIIOnITY TO VIOLA(E OR CANCEL 'IHE I•nOVISIONS OF I <br />.-. <br />0-YES ❑NO - <br />(t <br />ANY OTHER STATE On LOCAL LAW REGULATING ONa11 1UCT10N <br />FOR THE PERFORMANCE OF CONSTHUCITION. <br />TYPE OF CGNST. <br />GCCUPt.( CY GRCGI <br />-4O.OF O'.'7ELLi::G <br />UNITS <br />i <br />/ <br />SIZE OF SLOG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />IIASI MLNT <br />$IGNATU nE OF CUFIT RACTOfIDN AV T11. nG F',NT D.yTF <br />_ <br />(11/t ZONh <br />11 HLSPHINV LLI IS <br />REOUIREO <br />LAN CHLCK NUMUER <br />PLAN CIIL L'K I EL <br />❑YES ❑NO <br />_7__ "_�/.d'� _. <br />FEES <br />F LE� 3- RECEIPT 7 ) <br />� <br />VALUATION _ FEE <br />_...T._— <br />SPECIAL CONDITIONS: <br />_ <br />I <br />--ld_�..1✓i0 U <br />------- <br />s 5�d'-t 28P° <br />BUILDING <br />• PL II MIIINO <br />__._..._.. <br />I <br />SEPA REV{EW COMPLETE ❑YES ❑ NO <br />contact plonnlnq dept. <br />MECHANICAL <br />1,•__,., <br />I <br />OTHER <br />