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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 />OWNFR MAIL ADDRESS, Z'l' PLIUNL <br />ERIC HMACK <br />m <br />_ <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />C,.) m <br />_ <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />SIIOHOlaSH PEBG. <br />- <br />PERMIT <br />❑COMBINATION <br />❑BUILDING ®PLUMBING ❑MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ®REPAIR <br />VALUATION OF WORK <br />S <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />LEGAL DESCRIPTION OI: PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S I <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P, EA.------------ <br />1 <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />JOB ADDRESS •E I� <br />3o14 215t S+O <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEAL ERS-B.T.U. <br />P',_UMRING <br />EVAPORATIVE COOLERS <br />CLOTHEDRYERS <br />1 <br />VENTILATION FAN <br />RANGE HOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDING UNIT- C.F.M. <br />BATH TURS <br />S <br />CLOTHES WASHER <br />1 <br />WATER HEATER <br />DISH WASHERS <br />I <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAINS <br />1 <br />GAS. SYSTEM: NO OP OUTLETS <br />FLOOR DRAINS <br />1 <br />KITCHEN SINKS & DISP. <br />I <br />SUB TOTAL S <br />I <br />BAR SINKS <br />1 <br />PERMIT S <br />ROOF DRAINS - RAIN LEADERS <br />TOTAL FEE $ <br />1 <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 1 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 i �� <br />��' A ' { 6 8 <br />hli'L/+ I G!/vK <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 />1 <br />_— SUB TOTAL <br />Im <br />PERMIT <br />S <br />_— TOTAL FEE <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE <br />SIGNATURE OF CONTRACTOROR AUTH. 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 />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP UNO.NITOF <br />S DWELLING <br />BUILDING <br />$ <br />1 <br />1 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />11 100 <br />FIRE ZUNF, <br />BASEMENT FIRE <br />REQUIRED <br />SPRINKLERS <br />OYES ONO <br />MECHANICAL <br />1 <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />PENALTY <br />SEC. 3031A1 <br />I <br />---. <br />• C Zi T P <br />TOTAL <br />11 100 <br />�- <br />PERMIT VALIDATION 4 O t.E� c (I � [�:".RTnm� <br />WHEN PROPERLY VALIDATED 11 9EN4[, I'AGCww/ n�ov <br />VOU R 9ECElpTzZi' <br />Co <br />; TI ANK YOU N <br />1 F S <br />_ <br />AMLICATIU14ACCEPTLOBY' <br />PLANSCHECKLUBY. APPROVIIITORIEAIANCEBY <br />1• C• <br />ADDRESS FILE <br />__. . <br />i_i3'I _ .. • - - <br />