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di <br />,,,; �,� <br />ev�rett <br />CITY HALL.'S9�B745 <br />EVERETT, WA 98201 <br />CONSTRUCTIO. � <br />PERIlAIT <br />❑ COMBINATION XI�C BUILDING C� MECHANICAL <br />P�RN;ir No. 15392 <br />❑ PLUMBING <br />OWNER MAIL ADORE55 CITY 21P PMONE <br />Klein FIonda 7100 Evergreen Way Everett <br />ARCMIfECT OF �ESIGNER �1�IL A�DRESS CITY ZIP PHONE <br />GENERAL CONTfiACTOR MAII AOORESS CITY ZIP PNONE LICENSE M <br />Berry Neon Inc. P.O. Box 52G9 Lynnwood 98046 776-8835 <br />MECHANICAL WNTRACTOP h1AIL AO�RE55 CITY ZIP PHONE LICENSE N <br />BERRYN*297LD <br />PLUh101NG CONTRACTOR MAIL FO�flE55 CITY ZIP PHONE LICENSE N <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O DEMOLITION O FENCE }(�' SIGN <br />OF WORK <br />3876. <br />install illiuninated sign <br />LOT __ BLOCK _ OF <br />Evergreen Way <br />PLUMBING <br />N0. TYPE OF FIXTURE OP <br />W ATER CLOSET (TOILEI� <br />BATHiUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISP. <br />DISHWASHER <br />LAUNDFYTRAY <br />CLO7HES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK ISERVICE — BAR, ETQ) <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />1. ENVIRONMEN7AL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDPANT <br />4. FIflE PROTECTION SYSTEtd <br />5. GRADING <br />6. DRAINAGE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />B. HEALTH DISTRIC7 <br />❑ WOO� STOVEIFIREPLACE INSERT <br />I HEREdY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOVJ THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIOVS OF I.AWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCEOFCONSTRUCTION. <br />X NA7UflE'�TOR OR AUTHORREO AGENT ��! //� <br />c <br />MECHANICAL <br />ITEM FEE N0. TYPE OF E�UIPMENT FEE <br />AIR CONO. UNITS — H.P. EA. <br />REFRIGERA710fJ UNI75 — H.P. EA. <br />BOILERS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLEFS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />qANGEH00D <br />AIR HANDLING 11NIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />PLAflS CHECKED BY <br />S <br />S <br />IEAR YARD SETE <br />'ACANT SITE <br />VES i:NO <br />10. GF IIWELLIN <br />4AX. 000. LOAO <br />'IRE SPRINKLER� <br />IEOUIRED <br />VES i.NO <br />BY DA' <br />FOR <br />SUB TOTAL 5 <br />PEFiM1T 5 <br />TOTAL FEE 5 <br />PLAN GHECK FEE <br />FEE � RECEIPT NO. <br />FEES I VALUATION � FEE <br />BUILDING g gB�g, 2q 00 <br />PLUM6 NG <br />MECHANICAL <br />OTHER <br />PENALTY U.B.C. <br />SEC. 303 (a) <br />TO7AL 29 00 <br />PERMIT VALIOATION <br />WHEN PROPERLV VALIDATED (IN THI,$ �P�C�) THI�$�VI�U�i Pff�11T � <br />L 7 UL4 UU <br />M <br />Lt� <br />�:� :,, �.; r, r, r: c r- i�T .-; <br />�� �, �..i�� Y��U <br />. ii,� ,. <br />ADDRESS FII.f_ <br />I '� ��i � � <br />