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the Evergreen CONSTRUCTION <br />CITY OF PERMIT <br />everett <br />CITY HALL 259.8745 <br />EVERETT, WA 98201 COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />everett <br />,,e, <br />OWNER MAIL ADDRESS ZIP PHONE <br />William W. Burch 8041 Florida Drive <br />M <br />In <br />ARCHITECT OR DESIGNER MAIL ADOfl ESS PHONE LICENSE NO. <br />GENERAL CONT RACTOH MAIL ADDRESS PHONE LICENSE NO. <br />Same <br />z <br />C <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />E: <br />DO <br />m <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />ElCOMBINATION <br />® BUILDING ❑ PLUMBING ❑MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />S <br />❑)aMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />Move Residence <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />SE1 of the SWIa of Sec. 18, Twn. 28N, Rge 5 EWM <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />NO. <br />TYPEOFEOUIPMENT <br />FEE <br />AIR CONE). UNITS-H.P. EA. <br />$ 1 <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />1 <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />_r <br />1 <br />JOB ADDRESS <br />Move from 990"7th Avenue t0 <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS—B.T.U. <br />1 <br />PLUMBING 8041 Florida Drive <br />_ <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />Lot 3 Block 5 of Beverly <br />Park <br />VENTILATION FAN <br />T— <br />RANGEHOOD <br />1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />BATH TUBS <br />S <br />-- <br />CLOTHES WASHER <br />I <br />DISH WASHERS <br />I <br />WATER HEATER <br />�— <br />DRINKING FOUNTAINS <br />I <br />FAC. BUILT FIREPLACE & CHIMNEY <br />I <br />_ _ <br />FLOOR DRAINS <br />I <br />GAS. SYSTEM: NO OP OUTLETS <br />KITCHEN SINKS & DISP. <br />1 <br />SUBTOTAL $ <br />1 <br />BAR SINKS <br />I <br />PERMIT S <br />ROOF DRAINS - RAIN LEADERS <br />I <br />TOTAL FEE S <br />I <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 />x �/� 1./� �12/i; 75 <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />— <br />WATER CLOSETS <br />WATER HEATERS -ELECTRIC <br />I <br />WASH BASINS <br />I <br />LAUNDRY TRAYS <br />_ <br />I <br />I <br />SUB TOTAL <br />PERMIT <br />S <br />TOTAL FEE <br />WATER <br />SERVICE SIZE _ BLDG. SUP PLY <br />SIZE <br />SIG n U EOF CONTRACTOR TOR ORq 1H. AGENT DATE <br />SIDEYARDSETBACK <br />STREETSETBACK <br />REAR YARD SETBACK <br />FLAN CHECK NUMBER <br />PLAN CHECK Fi.L <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 />OCUUPANCY GROUP NO. <br />UNITS <br />OF DWELLING <br />1 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />BUILDING <br />$ <br />00100 <br />PLUMBING <br />I <br />FIRE ZONE <br />BASEMENT FIFIESPRINKLERS <br />REQUIRED <br />OYES ONO <br />MECHANICAL <br />1 <br />SPECIAL CONDITIONS: <br />OTHER <br />) <br />1 <br />— <br />PENALTY <br />SEC. 303(a) <br />I <br />TOTAL <br />.00100 <br />PERMIT VALIDATION - 1 <br />WHEN PROPERLY VALIDATED (IN TMPACA III <br />+py�'9j �R FER MI7T• <br />f.0 REWI'1• <br />TMANK YOU t-A. <br />O. <br />a Mp <br />— <br />e14DCAlION AUCFPlEU NY: <br />PLAMS E-KtUaY: APPROVLO <br />FOR IMUMCE RY <br />ADC!Rr ;; FiLf: <br />