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r <br />1■ <br />the Evergreen A.P P L I CATION FOP I YE FR„ <br />CITY OF CONSTRUCTION <br />everett PERMIT e <br />DFPT OF COMMUNITY DEVELO-ME 141 SER'/ICF5 <br />CITY HALL 2598745 <br />EVERETT. WA 98201 ❑COMBINA11ON BUILDING ❑AIECHANICAL ❑PLUMBING PERMIT NO. <br />OR DI IC.,R <br />ZIP <br />"INKNL C ON I KALI UK <br />MAII ADURESS <br />CITY <br />ZIP <br />PHONE LICENSER <br />4u o.� FO.kS..r <br />.i t lec <br />A/ _ <br />DV II411 oG <br />MI CHANII CONINP CIER <br />1 <br />MAIL ADURF S4 <br />UlY <br />P�N. 511 <br />_ <br />� <br />Y�IIC[N <br />1'I )'%III ION TRAC TOR <br />MAII ADDRESS <br />CITY <br />ZIP <br />PHONE OCTAL[ R <br />CI ASS OF WORK <br />❑NFW []ADDITIONtgA! <br />1I��S <br />IERATION ❑REPAIR <br />❑DEMOLITION ❑fENCE <br />❑SIGN <br />TA� <br />XrARAGE ❑BUILDING RELOCATION <br />SMwI,nN�Or NURR�//L� <br />9 <br />It EIRP�/ <br />�j <br />CZ <br />DISCRIBI WORK <br />a <br />, <br />RA7- d,;icl <br />didd ifay ony <br />L T <br />- ra e <br />v <br />I— <br />PROPOStO OF NmLD <br />el <br />p <br />1 HEREB'f CERTIFY THAT I HAVE READ AND) XA INED IS AP - <br />PL ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THif 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 REGULAf ING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIC.NATURE Of CONTRACTOR OR AUTHOR17ED AGENT DATE <br />/ <br />x r &1 <br />IIGM UISCAIPTIONOt PR RIY I$IIOW BII OSY OR AITMH FOUR COPHSI <br />LOTRL«K or 7 f. <br />/ <br />F <br />TOR AVERTS <br />p <br />PLUMBING <br />R F <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET ITOLIFTI <br />Alk COND UNITS —HP EA <br />BATHTUB <br />_ <br />REFRIGERATION UNITS-4 P EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GASFIRFDAC UNITS —TONNAGE FA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-8 T U MIA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-0 I U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— CENT <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLFADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE —BAR. ETC I <br />SUS TOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SI TRACK <br />STREET S T ACK III <br />REAR M O SFTBAyK <br />PLAN CH CK NUMBER <br />D l l a rp3 <br />PLAN <br />ff F�DF I? <br />CHECK FEE <br />RFC P L <br />USE ZONE <br />LOT AREA <br />rycf%f 3/%D <br />VACANT SIT-S <br />OYES :1 <br />FEES <br />VALUATION <br />FEE <br />TYPE I ONSi ��1 I <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S/ <br />f0 J <br />$III O _ 7.3o <br />NO OF ^4 HAi <br />MAXMA% OCC LOAD <br />PLUMBING <br />FIR[ LONE <br />BI,$EMFNi <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />C1YF5 (PND <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U BC <br />SEC JOXR) <br />2 BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 GRADINGE%CAVATION A CLIARINCIGRU84ING <br />PERMIT VALIDATION <br />WHEN PROPEREV VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />S HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />_ III <br />AVA FOR ISSUANCE BY <br />r <br />91.79 <br />