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APPLICATION FO"_ <br />the Evergreen <br />CITY OF CONSTRUCTION <br />CITY <br />evereH <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MML ADDRESS CITY ZIP PHONE <br />2N7Z-�01-- F-Lac)2S "1a I o c�crn e$v uPrf� 35 -�� rs <br />OR DESIGNER <br />MAIL <br />CITY ZIP <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />�L3'I�{2 i6 <br />L✓CUW Ca 2Fa7-7 Gf'u <br />LYNw 4111 95scl5G. '77G <br />—'V zlf7(-d <br />MECHANICAL CONTRACTOR <br />AIAIL ADDRESS <br />CITY LIP <br />PHONE <br />LICENSE X <br />LICENSE I <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />CLASS OF WORK �,,{ <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE iCN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK /' <br />I �SS� a d f (/S <br />DESCRIBE WORK <br />, I) <br />PROPOSED USE OF BUILDING <br />C Cn^- nl C--M CZ-p-c S-�f`N <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 PERFORMANCE OF CONSTRUCTION. <br />AAUTTHJORIZED AGENT DATE <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED <br />X /7 -3 <br />I�(. Gl�--�' I/ / <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK -Off <br />IOtl ADDRESS <br />G ld rVC-C6 2�riv �L yg <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 UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS—H P EA <br />SHOWER <br />GAS FIRED A UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS—B T U. M EA <br />DISWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-9 T.0 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 —RAINLEADE ITS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE —BAR. ETC I <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />RCAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />']YES ❑NO <br />FEES <br />VA. LUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />NL UROOMS <br />REQU REID KLE RS <br />F7YE5 ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />. <br />SEC307(a) <br />Z BUILDING PLANS <br />TOTAL <br />B FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION A CLEARING/DRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />�� <br />APPR. ft ANCE <br />I <br />9.179 L <br />a <br />