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APPLICATION FOR lYQTR„ <br />the Evergreen <br />an OF C O N S T R U C T I G, 4 e <br />everett PERMIT <br />DFPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HAEE 259.8745 <br />EVERETT• WA982O1 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />r UNMX MAIL AINRTSS (III III, PIIL141 <br />i <br />��fS Or:�L\ � VI?\ •LT �1L C� �S rd lh il'L ly.n 1, iJ:.4\.. (��: �i ''II"�(. <br />ARCHITECT OR DISIGNLR a MAIL ADURLSS CITE ZIP PHONI <br />�i 1oa 11I.Q'I SL• <br />O ENIRAL CONTRACTOR MAIL ADURISS j( Clll L� Zlr PHONI IICf NS[ P <br />L T2,.\ l\r•ao:('CI wl Li LA ZiA L•1!.I YA\` CC'CF1 L`\\ I, fi.)L}', z15 <br />Al1CHAMUI CONTRACTOR MAIL ADURISS CI11 LIP PHUNI LICINSI R <br />14L'MNING CONTRACTOR MAIL ADURISS CI11 ZIP THOM UCINRR A <br />LEAK UI WORK Y� <br />❑NEW ❑ADDITION Tg1ALTERATION ❑REPAIR ❑DEMOLMON ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUAPO401 WORK <br />L !- T),`. .� <br />m 5rxnn WPNK I 'SI ,'J p,: r. TI _ 'JC Cr\ <br />- t L... L,..•Y1f Ee �G I�ti � LJv L411i - K•,1.EP .(F I6 (-( 12 <br />I IIEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />rxuruSu)cM a1 xlnun4r. <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 />IIGIDHCRIPII(1N O1 PROM RIY ISNOWN pIIUN OR AIi ALIT TOUR CC1P1111 <br />OR NOT THE GRANTING OT A PERMIT DOES NOT PRESUME TO <br />to; _AHxK_OF <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 />SICNAIURTF CONTRACTO OR AUTHORIZED AGENT DATE <br />) <br />x r' LPL -r•' <br />u1H ADDRESS 1 { (1 <br />Fti.G fib! <br />4NV� It I, <br />L C• , <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />WATER CLOS[I(TOLIE II <br />AIR(OND UNITS-111• EA <br />REFRIGERATION UNUS-HP FA <br />RATHIUR <br />BOILERS -TIP [A <br />I AV41ORY[WASH BASIN) <br />GAS I IRf 1) A C UNI IS -TONNAGE f A <br />SHOW[ R <br />II)NCI D AIR SYSTEMS-B T U M EA <br />KITCHEN SINK A UISP <br />WAll fit All R5-If I M <br />DISWAMOR <br />ll NS - II I U AT <br />LAUNDRY INAY <br />I IVI COOT f RSWATER <br />( Llll III S WASH[ A <br />DRYERSION <br />HEATER <br />MC00il <br />TANURINALDRINKING <br />fOUNIAINOODILOOR <br />)IN(; UNIT- CF MVACUUM <br />DRAIN <br />BREAKERSROOF <br />DRAINS-RAINUADERS <br />RIPLACI A CHIMNEY <br />- <br />SINK ISFRVICI-BAR. IICI <br />SUB TOTAL S <br />SUB TOTAL <br />PERMIT S <br />PERMIT <br />IF <br />EEF S <br />TOTAL FEE <br />S <br />TOTAL <br />SIDE YARD 51 )HACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMULR <br />PLAN CHLCK I[L <br />RICTIPI NO <br />FIE <br />USE ZUNI <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />Fit <br />❑YES ❑NO <br />TYPE of CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LUAU <br />PLUMBING <br />FIRE ZONE <br />BASf MFNi <br />NI URUIISLt <br />TIREFUQREIOKLIRS <br />MF CIIANICAL <br />TYER FIND <br />APPROVALS <br />BY <br />DATE <br />OIHfR <br />I [NSIRONMENIAL CHECK LIST <br />PINAIit' <br />UBC <br />SFC FORM <br />1 BUILDING PLANS <br />TOTAL <br />1 I INI 111DNANI <br />R IIRI I`ROIICIIONSYSIIM <br />PERMIT VALIDAIION <br />WHEN 1'90PIKLY VALIDAIED(IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADING I RCA\AT ION A CLI ANING: C.RLIHIIIN(; <br />6 DRAINAGE <br />1 fNVIRONM[NTAI IMPACT STATIMINT <br />A MA.L THDISTRICT <br />I. <br />ION ACC BY PLANS CHECKED BY I APPR FOR ISSUANCE ITT <br />L•c:. <br />