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The Evergreen - APPLICATION F O R <br />CI TV oIT ONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA 98201 ❑COMBINATION <br />BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />ARCH ITLCT OR DINC.N IN MAIL ADDRESS / L CItY TIP PHONE <br />(NAM., <br />/ 6"14J/c��E.t PD�nx/iio3 �tFvr N6 f/ry l/1n/� �I <br />UNIRAI(ONTRAiIJ MAII ADDRf SS Y�� CITY ZIT' PHONE LICENSE/ <br /><r_ .z yS�/7� lGC1/f9d7 71.A/Z <br />MAIL <br />PHONF LICENSE R <br />PLUMBING CONTRACTOR MAIL ADDRISS CITY /IP PHONE LICENSER <br />CLASS OF WORK <br />_NEW_ ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE 5kSIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION QLWORK <br />!PC <br />DISCRIM, WORK [^ <br />PROPOSED usl DF Bunowc <br />/JA/✓ <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 PCRFA"t�CE NSTRUCTION. <br />GNATUR[O ONTjhCT OR THORIZED AGENT DALE <br />_ <br />LEGAL DTSCRIPTIDNOF PROPIRTVISHOWN SHOW OR ATTACH IOURCOPIISI <br />LOT _BIOCK_OF <br />L D Z Z <br />100 ADORE SS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE Of FIXTURE <br />FEE <br />NO. <br />TYPE O UIPMENT <br />FEE <br />WATER CIOS[T ITOLILTI <br />AIR CON) UNITS-H.P EA <br />BATHTUB <br />REf RIGERATIONUNITS-HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP IA <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE [A <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-13 T U. M I A <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRYTRAY <br />UNIT HEATERS --BTU. M <br />CLOT1415 WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />V[ NTII ATION FAN <br />DRINKING FOUNTAIN <br />RANGE I4O0D <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F AT <br />VACUUM BREAK[RS <br />STOVE <br />ROOF DRAINS-RAINI. FADERS <br />ATE TAL I IRE PEACE A CHIAINI Y <br />SINK(51 RVICE-BAR FTC) <br />SUB TOTAL <br />SUN TOTAL $ <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL TLf f <br />SIDE YARD SI TRACK <br />STREET 511 BACK <br />REAR YARD SETBACK <br />PI AN CHECK NUMBER <br />PL NN <br />III <br />CHICK III <br />RIC( ILL �n <br />USE ZONL <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />[its <br />VALUATION <br />EFT <br />TYPE OF CONST. <br />OCCUPANC GROUP <br />NO. OF DWELLING UNITS <br />WILDING <br />S pY� /, o <br />/ <br />3� <br />v <br />SIZE OF BLDG. <br />NO OF STORIES <br />MAX. OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASCMCNT <br />111 DRODNIS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES LINO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHICK LIST <br />PENALTY <br />U O.C. <br />SIC. 303(a) <br />2. BUILDING PLANS <br />3. FIR[ HYDRANT <br />TOTAL <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHIN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />• LA L <br />5 GRADINGif %CAVA7IONACLI ARING!GRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACE" III <br />PLiNSCHF KED FIN <br />PR <br />10 SUANCE IIY <br />