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the Evergreen <br />CITY Cc)NSTRUCTION <br />everett PERMIT PERMIT NO. _ 22032 <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL T PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Church of Jeusu Christ 9509 19th Ave. SE Everett 98208 337-4544 <br />TENANT MAILADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE r <br />PLUMBING CONTRACTOR <br />Owner <br />M.JL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE+ <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION <br />❑ ALTERATION <br />❑ REPAIR ❑ DEMOLITION <br />❑ BUILDING RELOCATION <br />CONTRACT PRICE OF WORK: $ <br />CONTACT PERSON AND PHONE NO. IF OTHER THAN ABOVE <br />DESCRIBE V.lnK AND SQUARE FOOTAGE INVOLVED <br />Install new backflow <br />preventer <br />PROPOSED USE OF BUILDING <br />Church <br />LEGAL DESCRIPTION CF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCX — OF <br />JOB ADDRESS <br />9509 19th Ave. SE <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXIURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.F. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. AT EA <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />_ <br />KITCHEN SINK 8 DISP, <br />VENTILATION FAN <br />DISHWASHER <br />FIAIJGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />1 <br />BACKFLJIV PREVENTERS <br />5 <br />00 <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />S <br />5 <br />00 <br />SUBTOTAL <br />$ <br />PERMIT <br />S <br />1 <br />00 <br />PERMIT <br />S <br />TOTAL FEE <br />f <br />S <br />'51 <br />00 <br />TOTAL FEE <br />$ <br />FRONTS -TRACK <br />REARSETBACK <br />SIDE SETBACK <br />PLAN CHI CK NUMBER <br />- Y /' <br />I �� <br />U.EZONE <br />LOT AREA <br />VACANT SITE <br />CI ❑ NO <br />FEES <br />ATC N Ea <br />rin FEE <br />BUILDING <br />CASH W.00 <br />TYPE OF C^_NSTPUCLON ALLOWABLE <br />TYPE OF CONSTRUCTION ACTUAL <br />�vWrpcv <br />NO OFOMLUNGUNTI3 <br />PLUMBING <br />15 <br />00 <br />SIZE OF BLDG <br />NO. OF STORIES <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />OCCUPANCYLOAD FIRE SPRINKLERS REO'O <br />❑ YES ❑ NO <br />REASON FOR SPRINKLERS <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING : IJRC4ARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC, BY <br />S.F. <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS <br />3105 <br />PUBLIC WORKS <br />TOTAL <br />15 <br />no <br />Wucu <br />PERMITS EXPIRE IF WORK IS NOT COMMENCED WITHIN <br />180 DAYS OP CEASES FOR MORE THAN 180 DAYS. <br />ADDRESS FILE <br />22032 <br />