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l�c (_u� EIID�Q APPLICATION FOK 2YfTCLL <br />the Evergreen CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 159-0745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNE�RY VAR ADDRESS CITY ZIP PHONE <br />ARCHITICi UROT SIGNER SAJ MAIL ADDRESS CITY )IP PHONE <br />GENERAL CONiRAC10R <br />MAII ADDRESS <br />CITY <br />(I" <br />VIION! <br />IIUN'f1R <br />`c_ <br />S S S 19 CO. <br />I I Q D S-tDo Aue <br />w sea=7 <br />9,9133 <br />�6s.DQ < <br />c s`1 <br />MICHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />IICTNSE R <br />PIUMRING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSER <br />Cl ASS OF WORK <br />52<EW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />%MVAOOS OF WORA CO <br />Y '�_aC10 <br />III %I'RISE WORK I�/I <br />, —L. II �_� � � CIL _1. � _Yf. o_ J,a. //d7AJocP l-)ya.'2 <br />PROPOSED Us[ OF RL•RDING <br />I HEREBY CERTI Y 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 WIE.L 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED ACENT DATE <br />xS ssux,,op. gwal.L 3lt3f9( <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />101 _RLOCK_OF <br />TOR AODRI55 <br />So oa��ws� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILET) <br />AIR COINED UNITS —HP EA <br />BATHIUO <br />I <br />REFRIGERATION UNITS — HP EA <br />IAVATORY (WASH BASIN) <br />BOILERS—H P EA <br />SHOW E R <br />GAS FIRED A C UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALL HEATERS —BTU M <br />IAUNDRY 7RAY <br />UNIT HEATERS—BT U M <br />CLOTHES YY'ASHH <br />EVAPORATIVE COOLERS <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 F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT f <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />- <br />SIDE YARD SETBACK <br />STREET SI. TRACK <br />REAR YARD SETBACK <br />PLAN CHECK N )VIER <br />PLAN <br />Fit <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT S1TE <br />OYES ❑NO <br />FEES <br />VALUATION <br />fEF <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAK OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />HI OROO.MS <br />FIRL SPRINKLERS <br />REQUIRED <br />EYES ETNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U it C <br />SEC J0l(al <br />1 BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />1 FIRE PROTECTION SYSTEM <br />S GRADINGIFXCAVAIICNACLEARINGICRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />I/ � <br />/``--�/ <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />