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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259 8745 <br />EVERETT. WA 98201 <br />CONSTRUCTION <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />OWNER MAIL ADDRESS LIP I'I^`" <br />MR & MS KIItIQ�AMDa 3006 19 98201 353-09 -- -- <br />ARCHITECT ORDESIGNER MAIMBRS PHONE LICENSE NO. <br />LICENSE NO. <br />m <br />m <br />z <br />C <br />W <br />m <br />GE NERAL CONTPACTOP MAIL ADO RESS PHONE <br />SAYE <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTfl ACTOS MAIL ADDfl ESS PHONE LICENSE NO. <br />PERMIT [CLASSO,F <br />❑ COMBINATION <br />QWILDING ❑PLUMBING []MECHANICAL <br />WORK <br />NEW ❑ADDITION ❑ALTERATION ❑PEPAIR <br />VALUATION OF WORK <br />S- <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRt BE 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 />(dp, <br />TYPE OF EQUIPMENT <br />FEE <br />AIR CORIND. UNITS-H.P. EA. <br />S <br />REFGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />- <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />ADDRESS <br />JOB DRES <br />JOB <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS- B.T.U. <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />�. <br />VENTILATION FAN <br />1 <br />RANGE HOOD <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />BATH TUBS <br />FEE <br />S <br />AIR HANDLING UNIT- C.F.M. <br />1 <br />CLOTHES WASHER <br />1 <br />WATER HEATER <br />DISH WASHERS <br />1 <br />FAC. BUILT FIREPLACE & CHIMNEY <br />1 <br />DRINKING FOUNTAINS <br />I <br />GAS. SYSTEM: NO OP OUTLETS <br />FLOOR DRAINS <br />I <br />SUB TOTAL S <br />I <br />KITCHEN SINKS & DISP. <br />I <br />PERMIT S <br />BAR SINKS <br />TOTAL FEE S 1 <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS. OR IF <br />CONSTRUCTION OFF 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 />x Q— <br />SIG U R E__OF'CUU NT RA OR OR AU .AGENT odT E" <br />PLA CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />_ <br />ROOF DRAINS - RAIN LEADERS <br />SHOWER BATHS <br />1 <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />WATER CLOSETS <br />1 <br />WATER HEATERS - ELECTRIC <br />1 <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />1 <br />1 <br />I <br />SUB TOTAL <br />PERMIT <br />S <br />TOTAL FEE <br />WATER SERVICE SIZE BLDG. SUPPLY SIZE <br />SIDE YAPD SETBACK STREET SETBACK REAR YARDSETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />T-- <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNO.NITOS DWELLING <br />1 <br />BUILDING <br />$66.00 <br />5.60 <br />--- <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX.00C. LOAD <br />PLUMBING <br />I <br />I <br />I <br />I _ <br />I <br />S. 0 <br />FIRE ZONE <br />BASEMENT <br />FIREIRED LERS <br />REQUIRED <br />YES ❑NO <br />❑YES <br />MECHANICAL <br />SPECIAL CONDITIONS: <br />OTHER <br />PENALTY <br />SEC. 3031a1 <br />— <br />TOTAL <br />PERMIT VALIDATION 1{�gj Tj 1$yS <br />WHEN PROPERLY VALIDATED L PAC o <br />iIil7fi ul1^;MIT <br />,� 1Y, YY9R Yi �1 <br />c� <br />YOUR RECEIPTi-A <br />THANK YOU "' <br />3 <br />APPLICA710NACCEPILDBY. <br />PLANS CRECKBDBY, <br />APPRWEDFOR I•SUMICEBT <br />EB <br />ADDRIHSti I -ILL <br />1 <br />I <br />.■ <br />i <br />