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h <br />the Evergreen A^ P L I C AT I O N F O 1� n®r <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT ai <br />CITY HALL 259.8745 PA <br />EVERETT.WA98201 nfEYMRINATInN PABUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />PLUMBING CONTRACTOR MAIL ADDNISS CITY ZIP PHONE LICINSE <br />CUSS OF WORK <br />❑NEW ❑ADDITION ,ALTERATION' ❑REPAIR []DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUAHON OF WORK <br />L ��tj4d <br />DISC BI WORK <br />%7 r ul t 6d `� Q u W u77;, yx/(o°XdL e n! <br />o <br />PRONISIU U516A RUILUING IEREBY <br />CERTIFY THAT I HAVE REACrAND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />I" b r iroom- <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LICAL OFSCRIPTION Of PROPERTY (SHOWN FHOW OR ATTACH FOUR COPES) <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />LOT <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />__REOCK_Of <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />�nl,o r I.i rKc <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR ORIZED IENT DATE <br />O S <br />F —�6 _ �. <br />X <br />Toe Anoaes <br />C2� <br />II2Y'L �O� <br />>' . <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIEII <br />AIR COND UNITS-H P EA <br />BATHTUB <br />REFRIGERATION UNITS -HP EA <br />LAVATORY IW ASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC. UNITS—TCNNAGE EA <br />KITCHEN SINK 6 DISP <br />FORCED AIR SYSTEMS-8 T U. MIA <br />DISWASHER <br />WALL HEATERS-117U M <br />LAUNDRY TRAY <br />UNIT HEATIRS—BTU M <br />CLOTHES WASHER <br />IVAPORATIVE COOLERS <br />WATER HIATIR <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—R.AINLE ACT RS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE —BM:. [IC) <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT <br />s <br />I PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STRE[T SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DYES ONO <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BAS[MUa HL DR[>UMS <br />SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />E1YI5 ❑NO <br />— <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />URIC <br />SEC. )07(e) <br />TOTAL <br />2 BUILDING PLANS <br />] FIRE HYDRANT <br />R FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGMXCAVATION 6 CLEARINGICRUHRING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />L <br />91 79 <br />