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APPLICATION FOR everett <br />the E'�'ergreen C I. N ST R U CT I O N e <br />CITY OP <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL OPLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />�%% Isv pr c Evr� r <br />&Rrrurrrr nR nmrWR AUII AODRi55 CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE IF <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE A' <br />PLUMBING- CONTRACTOR MAIL ADDRESS Lily ur <br />L pler <br />CLASS <br />❑NEW vORR❑ADDITION)OQALTERATION GREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />S <br />DESCRIBE WORK <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK -OI <br />JOB ADDRESS <br />I HERESY CERTIFY THAT I HAVE READ P"D EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO DE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIE_j 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 PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />. /p%7// d-q/y1w <br />G//' .G` e egeg,r <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND. UNIT5-H.P. EA <br />BATHTUB <br />RFFRIGER ;)ION UNI75-H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />SHOWER <br />KITCHEN SINK & DISP. <br />DISWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.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- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADFRS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR. ETC.) <br />llc/ooe k <br />SUBTOTAL <br />PERMIT <br />S <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />{'LAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG. <br />NU. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />EINKLERSREQUIR <br />OYES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303(a) <br />2, BUILDING PLANS <br />TOTAL <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THI5 IS YOUR PERMIT <br />-- <br />— r> <br />5. GRADINGIEXCAVATION & CLEARINGIGRUBWEIG <br />6, DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APVIRAIhBa ACC UY "LAN51,11IUTADI11 <br />!J'I'li <br />1!)R KtiI'ati('I ❑Y <br />