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r <br />r <br />the Evergreen APPLICATION FOP <br />CITM OF <br />CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.877S <br />EVERETT, WA 98201 $COMBINATION ❑ BUILDING <br />MAIL ADDKISS/ •� <br />❑MECHANICAL ❑PLUMBING PERMIT NO. <br />CITY <br />FIM <br />t/Ce <br />d2 ,� cv�( <br />... S� `1i6 v6 <br />G[NIRAI CO iRA(lOR <br />L L <br />MAIL DDRISS CITY <br />ZIP <br />MONT ❑CIMEI <br />MICHANIUICONTRACTOR <br />a L. A. <br />— <br />RI-v�-RR- 3oi1`o <br />MAIL ADDRESS CITY <br />ZIP <br />MONT UCINSL4 <br />PHONE UC[NSU <br />PLUMBING CONTRACTOR <br />MAIL AODRLSS CITY <br />ZIP <br />CLASS Of WORK <br />❑NEW ❑ADDITION <br />-A"1•1'11 Oi wOR <br />❑ALTERATION 6S,(tEPAIR ❑DEMOLITION ❑FENCE <br />❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />3 <br />_2:j90 <br />W//OORRA/KK <br />�/Q O n <br />PROPOSID USI OI BUIIDIW. <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 />SIGNATURE O CONiRACT`OR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL OISOIIPIION Or PROPT Tr ulloN au woe An Ace IOUR CD��PIIyj <br />./% <br />LOT BLocA of <br />IUa <br />vy <br />PLUMBING v <br />hlrC<A4ICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />W ALL R CLOSE I FOE IE 7) <br />AIR CONE) UNITS —HP [A <br />BATHTUB <br />REFRIGERATION UNITS—H P FA <br />LAVATORY IW'ASII BASIN) <br />BOILERS —HP EA <br />SHOWIR <br />GAS FIRED A C UNITS —TONNAGE EA <br />KITCHEN SINK 8 DISP <br />IORCED AIR SYSTEMS-8 T U MIA <br />DISWASHER <br />WALL HEAIIRS—BTU M <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UNIT HEATERS —BTU M <br />EVAPORATIVE COOLERS <br />CLO THISOMIRS <br />WATER HEATER <br />_ <br />URINAL <br />_ <br />VE NTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />ILOOR DRAIN <br />AIR HANDLING UNIT— CfM1I <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINL[AM ITS <br />SINK ISIRVICE —BAR, LICE <br />OFIRIPIACEffifll <br />SUB TOTAL <br />PERMIT S <br />TOTAL II[ S <br />SIDE YARD SEIHACK <br />STREITSLIBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />[IF <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />fits <br />VALUATION <br />_ <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />5 <br />SIZE OF BLDG <br />NO OF STORMUILDINGS <br />MAXMA% OCC TOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BE [)ROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑Y[S ONO <br />MECHANICAL <br />APPROVALS <br />W <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC. <br />SEC. 10Aal <br />Z BUILDING PLANS <br />3 FIR[ HYDRANT <br />TOTAL <br />A. TIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />vs 11 N PROVE NLr S'ALIDATEb TIN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADING[k XC'AVAI ION B CIA, RINGIGRUBIIING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED 11Y <br />APPR. FOR ISSUANCE RY <br />941-79 <br />L <br />