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the Evergreen APLJICATION FOR everen <br />CITY OF CONSTRUCTION e� <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 (�I <br />EVERETWA98❑COMBINATION ElBUILDING ❑MECHANICAL MPLUMBING PERMIT NO. <br />Off/ NER A ((YA MAIL ADORISS CITY ZIP PHONE <br />1<ICI. ilk Ir YJ pn ^j C 11AA IrrAS IA c7T CAA)rOAsvrm, EldUYL 4j/Y^-241_7)9�/1 <br />ARCHITECT OR DISIGNIR <br />MAIL ADDRI SS <br />CItY <br />ZIP <br />PHUNt <br />GIN I RAI CON I FACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE EICENSEIF <br />SII CIIANK At CONTRACTOR <br />MAIL ADORLSS <br />GIY <br />ZIP <br />PHONE LICENSE <br />\ ............. ........ <br />..... .......... <br />rIry <br />nP <br />PHONE LICENSE I_ <br />[KNEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />AALUAIION Of WORK _ <br />1 <br />ON( RINE WORK <br />Fi.".,-_n/A Tom.-I-.1 - I A I <br />7U111, M oI NDImNG <br />EiR i L- 5 I'{-t; S <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW i HE 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 PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED ACENT DATE -19 R 0 <br />x <br />LEGAL OISCRIPIION Of PROPERTY (SHOWN BELOWOR ATTACH FOUR COPIIS) <br />LOT _BLOCK_Of <br />/Y <br />CASE E pl � -E 2 <br />FOR ADDRI SS <br />-7Gb I F_vcpc-,,k1=L= uJ w4 v <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 />AIRCOND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS —HP EA <br />IAVATCRY IWAill BASIN) <br />/ <br />BOILERS -TIP EA <br />SHOWER <br />GASFIREDAC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRY TRAY <br />UNIT WATERS —BTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />A <br />/ <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 —RAINLEADE ITS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICL—BAR, ETC) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />j <br />PERMIT S <br />TOTAL FEE <br />S <br />— <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET S[TR ACK <br />REAR YARD SCIBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SHE <br />DYES GNO <br />FEES <br />VALUATION <br />FEE <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 />L-1 <br />FIRE ZONE <br />BASEMENT <br />IIIOROOAIS <br />FIRE SPRINKLERSREQUIR_ <br />F YFS FIND <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SIC J0J(a) <br />2 BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />_ <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGII XCAVATION A CLE ARINGIGRUBBIHG <br />G DRAINAGE - <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC <br />7BYPLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />91-79 <br />