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floe EveNgreen <br />CITY OF <br />everett <br />CITY HALL 2508745 <br />EVERETT. WA 08201 <br />CONSTRUCTION <br />PERMIT <br />COMBINATION • BUILDING • MECHANICAL • PLUMBING <br />OWNER MAIL ADDRESS : it vui iNl <br />Brandvold 1721 63rd Street <br />ARCHITECT OR DESIGNER - MAIL ADDRESS PHUNI LICENSE NO <br />I NRRM. CONTRACTOR MAIL ADDRESS Pf10NE LICENSE NO <br />Natural Gas Equipment <br />1229-77 m <br />7 <br />z <br />C: <br />IANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />3 <br />DJ <br />m <br />'.'IIING CONTRACTOR MAIL ADDRESS PHONE LICEW;1'NII <br />Do <br />,%ItT <br />❑COMBINATION n I) <br />MECHANICAL BUILDING ❑PLUMBING MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑nODIT10N ❑AI.TE RATION ❑REPAIR <br />"ATInN OF WORK <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POO( <br />TRIBE WORK <br />"OSED USE <br />MECHANICAL <br />TYPE Of ENERGY <br />❑OAS ❑ELEC. <br />%L DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH <br />I iniR 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 />I <br />FORCED AIR SYSTEMS-R.T.U. MEA. <br />JOB ADDRESS <br />SPACE d WALL HEATERS - B.T.U. <br />UNI' HEATERS H.T.U. <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />_ <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGE HOOD <br />I <br />NO. <br />_ <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT C.F.M. <br />BATH TUBS <br />_ <br />1 <br />-1 WATER HEATER _ <br />fAC BUILT FIRFI'Ln CL h CHIMNEY <br />- - ---- <br />GAS_SYSTF M NO OP OUTLETS <br />_ SUB TOTAL S <br />_ PERMIT $ 3 <br />TOTAL FEE $ <br />THIS PERMIT ULCOML S NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTHOnIZEO IS NOT COMMENCED WITHIN 120 DAYS, OR If <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR n <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEO <br />I HEREBY CERTIFY 1 HAVE READ AND EXAMINED AP <br />PRIVATION AND KNOWWTHE SAME TO BE TRUE AND CORRECT. API <br />ORDINANCES GOVERNING THIS TYPI <br />PROVISIONS OF LAWS ANDCOMPLIED HEREIN <br />OF WORK WILL RE COMPLIED WITH WHETHER SPECIFIED PRESUME 70 <br />GI NOT, HO GRANTING OF A PERMIT GOES NOT OVIIN01 <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OI <br />nOTHER STATE LOCAL LAW REGULATING CONSTRUCTION <br />nilil Tilt PERFORMANCE OP CONSTRUCTION. <br />8/12/77 <br />X <br />SIGNATURE Ae <br />OF CONTRA T AORAUTIC AAGGLLNT DATE <br />CLOTHES WASHER <br />DISH WASHERS <br />I <br />DRINKING FOUNTAINS <br />FLOOR DRAINS <br />KITCHEN SINKS & DISP. <br />BAR SINKS <br />ROOF DRAINS - RAIN LEADERS <br />SHOWER BATHS <br />_ <br />- --I- <br />-- 1 <br />1 <br />i <br />_ <br />I - <br />-I- - - <br />I <br />I <br />S i <br />.__ <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP -- <br />URINALS -_ <br />WATER CLOSETS <br />WATER HEATERS -ELECTRIC <br />WASH BASINS <br />LAUNDRY TRAYS <br />SUB TOTAL <br />PERMIT <br />TOTAL <br />II SERVICE 512E BLDG. SUPPLY <br />SIZE <br />rARDSETBACK <br />.'ONE <br />STREET SETBACK <br />REAR YARDSETBACK <br />PLAN CHECK NUMBER <br />PI AN CHECK FEE <br />FEE RECEIPT NO. <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NJ. OF DWELLING <br />UNITS <br />_ <br />1 <br />1 <br />I <br />I — <br />BUILDING <br />PLUMBING <br />S <br />SIZE OF BLDG. <br />NO. OF STORI'S 1Wf.K. <br />OCC. LOAD <br />FIRE ZONERA <br />1 i S RINKL IS <br />REQUIRED <br />OYES ONO <br />MECHANICAL <br />IG <br />SPECIAL CONDITIONS <br />OTHER <br />I <br />_ _ I <br />I <br />I <br />PENALTY <br />SEC. 303(a) <br />-------- <br />TOTAL <br />----! -- <br />PERMIT VALIDATION <br />WHI N I•110P1 RI Y VAI. IDATED R11915'ACLI DID15I o1ol I'=11I I <br />YO'uh 9ECEIFf <br />, THANK YOUcc' <br />u . <br />--- <br />-- <br />---------- <br />..IpI KA,IfIII GC(:IPIHI„. <br />IPIAN""Ummlvi` A"HoV11) <br />mi, IS'mmI Ilv <br />ADDRESS FILF <br />L?Am77 <br />