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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 ZIP PHONE <br />Donald P. Carlson 2718 21st Street 252-9594 <br />.T <br />m <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />-i <br />GENERAL CONTRACTOR MAtL ADDRESS PHONE LICENSE NO. <br />Sams <br />z <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />OJ <br />G / R1 <br />PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS LICENSE NO.G.' <br />PERMIT CLASS <br />❑COMBINATION <br />❑ BUILDING [:]PLUMBING ❑MECHANICAL <br />OF WORK <br />[I NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />$6000.00 <br />❑DEMOLISH [:)FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />relocate kitchen - family room <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY <br />[]GAS ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOU COPI 1 <br />LOT &BLOCKI6 Ready Land Company 1st <br />Np, <br />TYPE OF EQUIPMENT <br />FEE - <br />AIR COND. UNITS -HIP. EA. <br />REFRIGERATION UNITS-H.P. A. <br />BOILERS-H.P. EA. <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />00 <br />I <br />JOB ADDRESS <br />2718 21st Street <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS- B.T.U. <br />1 <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />_? 1 00 <br />VENTILATION FAN <br />_ <br />RANGEHOOD <br />OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />S <br />1 <br />jDjOUNTAINS <br />ASHER <br />I <br />WATER HEATER <br />RS <br />I <br />_ <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />NS <br />I <br />GAS. SYSTEM: NO OP OUTLETS <br />I_ <br />NS <br />I <br />SUBTOTAL S1"IDDITCHEN <br />SINKS & DISP. <br />I <br />T-1"�V�' <br />PERMIT $ <br />TOTAL FEE $ I <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR C NS UC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />PERIOD OFT120 DAYS AT ANY TIME AFTER WORK SDCOMME CEO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />FLICATION 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 OFF CONSTRUCTION. <br />- 12/1/77 <br />X IFrO� <br />BAR SINKS <br />ROOF DRAINS -RAIN LEADERS <br />SHOWER BATHS <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />WATER CLOSETS <br />I <br />WATER HEATERS - ELECTRIC <br />I <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />I <br />1 <br />SUB TOTAL <br />PERMIT <br />S <br />TOTAL FEE <br />0 <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZEAN <br />SIGNATURE OF CON] RACTOROR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />/14 <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITS DWELLING <br />IT <br />I <br />I <br />BUILDING <br />S 61000. 00 <br />36 100 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. LOAD <br />PLUMBING <br />9 100 <br />FIRE ZONE <br />BASEMENT <br />FIRESPRINKLERS <br />REQUIRED <br />DYES ONO <br />MECHANICAL <br />17 100 <br />I <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />w <br />PENALTY <br />SEC. 3031P) <br />I <br />. — <br />TOTAL <br />62 i00 <br />I • IDATIO v PERMIT <br />WHEN PROPERLY VALIDATED (IN T 11 PACEI 1 <br />ff <br />R RECEIPT.-c' <br />YOU YOUR ROEC EtP o <br />! THANK YOU <br />sli um 17 <br />• I M^ 7i <br />y0 <br />m ,. <br />APPLICA110N CfAQUIIY. <br />iLAN5 C11f CKtU NY'. <br />AI'P110VIU(OIIISAIANCC pY <br />eb <br />