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the Evergreen <br />CITY OF <br />APPLICATION FOR <br />,.,ONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />everett <br />a <br />CITY HALL 259-8745 <br />EVERETT, WA98201 EDCOMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER M1UIL ADDRESS C17Y ZIP PHONE <br />LGP.y -iiL j G-ol ia73"wru ev' „I, rl'- G-'J — - <br />ARCHITECT OR DESIGNER MAIL ADDRE55 CITY ZIP PHONE <br />SlrUcrlLr-� (��F^-c. 2��� n4aPLE:= C� slEucG�lcz7Ile <br />�i_ <br />GENERAL <br />ADDRESS <br />MECHANICAL CONTRAC70R MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />PIUMRING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />CLASS OF WORK rrhho� <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE L7SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF W JRK <br />--o0, _ <br />WORK <br />r. .—J-I lia <br />t�YT- FFCIt7 % uN-• <br />- <br />v v <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE Or BUILDING <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 />LEGAL DESCRIPTION OF PROP[ R7Y (SHOWN BELOW OR ATTACH FOUR COPIES) <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />EDT BLOCK -Of <br />TO VIOLATE OR CANCEL THE PROVISIONS OF <br />GIVE AUTHORITY <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAIUR'EOFFF CCONT TOR OR AUTHORIZED AGENT DATE <br />I <br />JOB ADDRESS <br />Y <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />AIR COND UNITS -HP EA <br />WATER CLOSET (TOLIET) <br />REFRIGERATION UNI75-H P [A <br />BATHTUB <br />BOILERS -HP EA <br />9 <br />LAVATORY (WASH BASIN) <br />GA$ FIRED A C. UNITS -TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS -BTU. M EA <br />KITCHEN SINK 8 DISP <br />WALL HEATERS- BT1J M <br />OISWASHER <br />UNIT HEATERS -BTU M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />- <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- CFAI. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE & CHIMNEY <br />ROOF DRAINS -RAINLE ADERS <br />SINK (SERVICE -BAR. ETC I <br />SUB TOTAL S <br />SUBTOTAL <br />PERMIT S <br />PERMIT <br />$ <br />TOTAL FEE 5 <br />7OTALFEE <br />STREET SETBACK <br />S <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />SIDE YARD SETBACK <br />FEE RECEIPT NO, <br />FEfS VALUATION FEE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />EYES ENO <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />5 <br />SIZE OF BLOC <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE ZONE BASEMENT OI UROOMS <br />REQU REIDKLF RS <br />OYES END <br />APPROVALS <br />BY DATE <br />OTHER <br />i. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC. <br />SEC. 701(al <br />2. BUILDING PLANS <br />TOTAL <br />T. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY ,'ALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION&CLEAR INGIGRUBRING <br />6. DRAINAGE <br />' IIQ / i1J'✓ �'C.,L'L� ^�"✓�"'��, <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />APPLICATION <br />PLC N$ [HE BY <br />APPR FOR ISSUANCE UY <br />4.1-79 <br />