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�heEvergreen � C�ISTRUCT�ON � <br /> CITY OF <br /> evere� PERI�IT pERMIT NO. O�Q7H <br /> CITY HALL 2E9�87A5 <br /> EVEREiT,WA 982C'1 ❑ COMBIN/ETION ❑ BUILDING i� R7ECHANiCAL ❑ PLUMBING <br /> OWNEF � MqILADDPE55 GITI' ZIP PNOHE <br /> Humphrey Vo]�swagen 5500 Evergreen Way Eyerett 353� 1192 <br /> � <br /> ARGHITEGIORDESIGNER MAILAOpflE55 Cltv ZIP PHONE <br /> I <br /> GENERALGONTRFCiOfl MAILAD�RE55 CITV ZIP r_HONE LICENSE! <br /> Simco Sian Coro 2719 Maole Fve Pt+ �s�' nnati _,,,cr py, ns r.�72 pg ; <br /> MEGHANICALCONTRFCTOR MAILAOORE55 CITY — ZIP PMONE UGENSEI <br /> � <br /> PLU!ABIHGGONTRACTOF MAILADDREES CITY ZIP PM@1E UCENSE:1 <br /> CLASS OF WORN I <br /> ❑NEW ❑ADOITION ❑ALTERATION ❑REPAIR ❑DEMOLITION L7FENCE �SIGN ❑GARAGE <br /> VALUATION OF WORK <br /> E 2500.00 <br /> DESCRIBE WORK <br /> Move existin Pole si n on Pro w <br /> PROPOSED USE OF DUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> IEGAlOESCRIPTIDNOFPROPERTY�SNOWBELOWOflAifACMFOURCOPIES) PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br /> �or e�oc�_oF TYPE OF WORK WILL BE COMPLIEI? WITH WHETHER SPECIFIED <br /> HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCELTHE PRO� <br /> VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR T �F PERFORMANCE OF CONSTRUCTION. � <br /> J00 AODRE55 SIGNATURE OF C0�" UtHOPIZEO AGENT OATE <br /> 5500 Everareen way X �-��.�� 21 79 <br /> PLUMBING MECfiANICAL <br /> NU. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET QOILET) AIR COND.UNITS—H.P.EA. <br /> BATHTU� REPFIGERATIOIJ UNITS—H.P.EA <br /> L4VATORY(WASH BASIN) BOILEFS—H.B EA. <br /> SHOWER GAS FlRE�AC. UIJITS—TONAr.BC cH. <br /> KITCHEP:SINK 8 DISP. FOACED AIR SYSTG1dS—B T.U. M EA. <br /> DISHWASHER WALLHEAiERS—B.T.U. td <br /> LAUNDRY TRAY UNIT HEATEFiS—B.T.U. M <br /> CLOTHES WASHEF EVAPORATIVE WOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> �RINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANOLING UNIT— GF.h1. <br /> VACUUPA BREAKERS STOVE <br /> FOOF DRAINS—RAINLEAGEFS �dETAL FIREPLACE 8 CHIMNEY <br /> SINK�SERVICE—BAR.ETC.) I <br /> I <br /> � <br /> SUBTOTAL SUBTOTAL 5 I <br /> PEHIAIT S PERMIT S I <br /> TOTAL FEE S TOTALFEE S <br /> SIDE VARD SETBACK STREET SETBACK REAR YARD SETBACK PLAN CHECI;NUMBER PLAN CHECK PEE � <br /> FEE RECEIPT N0. <br /> USE ZONE LOT AREA VACANT SITE I <br /> ❑YES ❑NO FEES VALUATION FEE j <br /> TVPE OF CON57. OCCUPANCY GROUP NO.OF DWELLING UNITS � <br /> BUILDING S 2500,00 12 00 � <br /> SIZE OF BLDG. NO.CF STORIES MAX.OCC.LOAD <br /> PLUMBING <br /> FIRE ZON[ BASEMEN7 FIRE SPRINKLERS — � <br /> REOUIRED MECHANICAL �� <br /> ❑YES ❑NO <br /> APPROVALS BY �ATE OTHER I <br /> 1. ENVIRONMENTAL CHEGK LIST PENALTY U.B.C. I <br /> 2. BUILDING PLANS SEC.303(a) <br /> 3. FIRE HYURANT T�TA� I <br /> 12 00 <br /> 4. FIRE PROTECTION SYSTEM PERMIT VALIUATION <br /> WHEN PROPEFLY VALIDATEO(M THIS SPACE)THI515 YOUR FERMIT <br /> 5. GRADING Q (� (� ..-.�^,�,�.,y,1,' <br /> 6. DRAINAGE 6 2 8 6 .J U � �. �+ O � ' ` <br /> 7. ENVIFONMENTALIMPACTSTATEMENT �l <br /> B. HEALTH UISTRICT <br /> APPLICATIQN ACC,BY PLANS CHECKED BY APPR.FOR ISSUANCE BY YO U R F E C E i P' <br /> i i-�nI�K YO U <br /> ADDRESS FILE � 4 �C 79 <br />