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J" P I_ I t: M I OI N F O I UYereli <br />OF <br />C Evergreen <br />G11Y CONSTRUCTION <br />everett PE RNA IT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 gCOMBINATION ❑BUILDING ❑MECHANICAL_CIPLUMBING PERMIT NO, <br />OWNER 1) r M,yAT} ADDRESS 5'C CITY / ZIP PHONE <br />WF11117m 0 7jq[F.f51'l 957G /5ri/1d1= �5 eaeLT °/-4 357- );73I/ <br />ARCHITFCT OR DESRINER MAIL ADDRESS CITY ZIP PHONE <br />S to 04 fE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICE NSEIF <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE If <br />PI UMPING LONIRACIUK <br />.S+/E(1Cf2 {ter <br />CLASS OF WORK <br />❑NEW ❑ADDITION <br />VALUATION OI W K <br />OIiCRIBE WORK (Yq vFn .n <br />MAIL <br />71 <br />NALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE. ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />. I Ci <br />PROPOSED USE Of BUILDING <br />P91'Tv1 Y44 6 kef <br />1 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. �'J g <br />SIGNATURE OF CONTRACTOR OR A'UFT)/F�/{/1IORIIEZZEEE(DDI-AGENT DATE I�.(-✓-OI <br />MECHANICAL <br />,[4.AL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPI15) <br />._ <br />LOTBLOCK -OF <br />TOR ADDRESS <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO, <br />TYPE OF EQUIPMENT <br />FEE <br />w ATER CL05ET JOLIET) <br />AIR COND UNITS —El P EA <br />BATHTUB <br />REFRIGERATION UNITS—H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWfR <br />(;AS FIRED A UNITS —TONNAGE EA <br />KITCHEN SINK B DISP <br />FORCED AIR SYSTEMS —BTU M FA <br />OSWASHER <br />WALL HEATERS—B.T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS—B T U M <br />,CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />1 <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.FM. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RL.INLEADERS <br />METAL FIREPLACE A CHIMNEY <br />F/ <br />SINK ISERV,CE —BAR, FTC I <br />SUB i07AL <br />SUBTOTAL f <br />PERMIT <br />3 <br />PERMIT $ <br />-_—_ TOTAL FEE <br />3 <br />TOTAL FEE f <br />SIDE VARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />II( <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT Slit <br />OYES DNO <br />FEES <br />VALUATION <br />FEE <br />TYPE Of CONSSTT. <br />'PE <br />`" -' H^ <br />OCCUPANCY GROUP <br />15L AbD LIJ <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG. <br />1' 5 S.f. A D <br />NO OF STORIES <br />1 <br />MAX OCC LOAD <br />PLUMBING <br />FIRL ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRE <br />❑YES O <br />MECHANICAL <br />— <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONML NTAL CHECK LIST <br />PENALTY <br />U.B_C. <br />SEC 303(a) <br />7. BUILDING PLANS <br />TOTAL <br />-- <br />3 FIRE HYDRANT <br />1. FIRE PROTECTION SYSTEM <br />- <br />PERMITON <br />TPROPRLYII VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />5 CRADINGLXCAVATIONBCLFARR,GIGRUBBINC <br />6 DP.AINAGE <br />it <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />_ <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR IS`iUANC-E BY <br />/& <br />