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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 />OWNER MAIL ADDRESS ZIP PHONE <br />Benton McCarthy Realty <br />,D <br />rn <br />-- -- <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />z <br />C <br />GENERAL CONTRACTOR MAIL ADDRESS - PHONE LICENSE NO. <br />Heath NorthWest HE AT HN 330RJ <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Q <br />Ci - M <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />G <br />PERMIT <br />❑COMBINATION <br />❑BUILDING ❑PLUMBING [:IMECHANICAI. <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />$ 400.00 <br />❑DEMOLISH ❑FENCE SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />erect illuminated sign <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF ENERGY <br />❑GAS ❑ELEC. <br />LEGAL DESCRIPTION OF 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 />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />I <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />JOB ADDRESS <br />9610 Evergreen Way <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS-B.T.U. <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I _ <br />VENTILATION FAN <br />T— _ <br />RANGEHOOD <br />I _ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT— C.F.M. <br />BATH TUBS <br />S <br />1 <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />- <br />DISH WASHERS <br />I <br />FAC. BUILT FIREPLACE & CHIMNEY <br />DRINKING FOUNTAINS <br />I <br />GAS. SYSTEM: NO OF OUTLETS <br />I <br />FLOOR DRAINS <br />I <br />SUB TOTAL $ <br />KITCHEN SINKS & DISP. <br />I <br />B, R SINKS <br />I <br />PERMIT $ <br />ROOF DRAINS - RAIN LEADERS <br />I <br />TOTAL FEE S <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 I 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 />9�18�7B <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 />LAUNDPY TRAYS <br />1 <br />SU 8 'rO TA L <br />PERMIT S <br />TOTAL FEE <br />WATER <br />SERVICE SIZE BLDG. SUPPLY <br />SIZE'SIGNATURE <br />OF COD JK OR 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 />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />I <br />BUILDING <br />$ 400.00 <br />3 1 00 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC, LOAD <br />PLUMBING <br />I <br />FIRE ZONE <br />BASEMENT <br />FIRESPR INKLERS <br />REQUIRE ❑YESIR D ❑NO <br />MECHANICAL <br />I <br />SPECIAL CONDITIONS' <br />OTHER <br />1 <br />I <br />PENALTY <br />SEC. 303(a) <br />1 <br />TOTAL <br />3 j 00 <br />VALIDATION WHENPROPERLY 08 b. <br />VHENROPERLV VALIDATEDQ ACE) I L Y l NaRLAIT 1- <br />YQUREGEtP� <br />71JV� Y�41 � t <br />$,; 18 <br />ADDRESS FILE <br />