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the Evergreen „� CONSTRUCTION everett <br /> CITYOF PERMIT <br /> everett <br /> CITY HALL 2598TA6 BUILDING MECHANICAL PLUMBING .e <br /> EVERETT. WA 98281 COMBINATION <br /> OWNER MAIL AOOIO.s[V IIP PHONE <br /> 9, m <br /> Loren Sand 2107 61st 98203 355-C rs�-rw' <br /> ARCI/ITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br /> 1195-77 3 <br /> GENERAL CONTRAC-OR MAIL ADDRESS PHONE LICENSE NO. Z <br /> Same r- <br /> MECHANICAL CONTRACTOR MAIL ADDRESS PIIONE LICENSE NO. W <br /> (.) m <br /> PLUMBING CONTRACTOR MAIL ADDRESS <br /> PHONE LICENSE NO l <br /> PERMIT CLASS OF WORK <br /> ❑COMBIN ATION <br /> []BUILDING ❑PLUMBING ❑MECHANICAL [I NEW ❑ADDITION ❑ALT ERATION ❑RFPAIR <br /> VALUATION OF WORK ^ <br /> S 200. 00 ❑DEMOLISH R1_IFENCE ❑SIGN []SWIMMING POOI <br /> DESCRIBE WORK A <br /> erect fence <br /> PROPOSED USE MECHANICAL <br /> TYPE OF ENERGY <br /> LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR AiTACl/ ❑OAS ❑ELEC. <br /> FOURGqp IESI NO. TYPE OF EQUIPMENT Fn <br /> LOT 11 BLOCK_OF Pinehurst Div. B <br /> AIR COND. UNITS-H.P. EA. S .. <br /> REFRIGERATION UNITSH.P, EA. <br /> BOILERS HP.EA. 1 _. <br /> FORCED AIR SYSTEM3-B.T.U. MEA. -_ <br /> 1 <br /> JOB ADDRESS SPACE 6 WALL HEATERS - A.T.U. <br /> 2107 61st Street UNIT HEATERS- B.T.U. <br /> EVAPORATIVE COOLERS _- <br /> PLUMBING CLOTHES DRYERS I _ <br /> VENTILATION FAN <br /> RANGE HOOD 1 _. <br /> NO. TYPE OF FIXTURE OR ITEM FEE AIR IIANUI.INA 11N11 C.F.M. <br /> BATH TUBS _ <br /> CLOTHES WASHER _WATER IIFATER _- <br /> DISH WASHERS I FAC. BULLI I IREPLACt A CHIMNEY____ 1 <br /> DRINKING FOUNTAINS ppg, fiYSTI:M NO nP OUTLETS <br /> FLOOR DRAINS --- SUR TOTAL S I <br /> KITCHEN SIN IS ----- -- PERMIT S <br /> BAR SINKS --- ------- - <br /> ROOF DRAINS - RAIN LEADERS TOTAL FEFIS 1 <br /> SHOWER BATHS UiIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br /> _ SERVICE SINKS TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS,OR IF <br /> SUMPS - SEWAGE PUMP _ CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br /> PERIOD OF 120 DAYS AT ANY TIME AFTER WORK ISCOMMENCED. <br /> URINALS I HERERY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP <br /> WATER CLOSETS PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> WATER HEATERS - ELECTRIC I PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> WASH BASINS j OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> LAUNDRY TRAYS OR NOT, THE GRANTING OF A PERMIT GOES N07 PR ES•IME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISrM9 OF <br /> ANY OTHER STATE OR LOCAL LAW REGUI-ATING CONSTRUCTION <br /> I OR T11E PERFORMANCES or CO <br /> NSTRUCT ION. <br /> SUB TOTAL — - 11,11i: C'T6 Tt B�S�77 <br /> PERMIT f <br /> WATER SERVICE SIZE BLDG.SUPPLY SIZE S N EOF CONTRA RO AVTH.AGENT GATE <br /> SIDE YARD SETBACK STREET SETBACK REAR YAnDSETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> VSE ZONE LOT AREA VACANT SITE <br /> ❑YES []NO FEES VALUATION -�— <br /> TYPE OF CONST. OCCUPANCY GROUP UNI OF OWE LLING 1 <br /> SIZE OF BE NO.OF STORIES A%.OCC. LOAD BUILDING S 200.00 5�0� <br /> 1 <br /> PLUMBING <br /> TIRT 11 ZON BAS T REOUIREIO L RS <br /> ❑YES <br /> ONO MECHANICAL. <br /> 1 <br /> •IPI (AAL CONDITIONSOTHER 1 <br /> PFNAL1Y SEC.3031.1 1 <br /> 1 <br /> -- TOTAL S IOD <br /> ---------" ---" --- _ PERMIT VALIDATION 0Y1I <br /> ,NIIFNPRUPFRIYVAI IOAIFIIN Y CLI <br /> IY•7`� 'Y <br /> ---- ----- - -- YOUR RECEIPT <br /> — - ----- THANK YOU <br /> +•IununN ACc1 PII t,IIr pAN1I:NI LAI II Nr nM INOII,I, <br /> UII,Y <br /> e.U. . <br /> — In <br />