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i Uii k <br />.. y <br />APPLICATION FOR <br />the Evergreen I,bNSTRUCTiGI� <br />CITY i)>: PERMIT <br />everett ERVICES <br />DEPT. OF COMMUNITY DEVELOPMENT S <br />CITY HALL259-8745 ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />EVERETT, WA 98201 ❑COMBINATION El BUILDING L11, PHONE i �// ' % GIlY , G!' <br />OWNER <br />WW NE —1 L <br />1 / / MAIL ADDRC55 y �� <br />_7 -g( /� <br />% li v' 'i�L'v)�> I Y DD <br />/ - 0 CITY ZH, PITON[ <br />MAIL ADDRESS <br />ARCHITECT OR DESIGNER <br />CHI ZIT' <br />PHONE LICENSE E <br />MAIL ADDRESS <br />GENERAL GDNTRACTDR LICENSE A <br />Cllt <br />LIT' PITON[ <br />MAIL ADDRESS <br />MECHANICAL CONTRACTOR LICENSE F <br />UlY <br />:IP PHON[ <br />MnIL ADOd65 <br />PLUMBING CONTRACTOR <br />CLASS Of WORN <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OFWORK <br />S <br />DESCRIBE WO <br />e512 !� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PROPOSED USE OF BUILDING PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPHON OF PROPERTY (SHOWN BtI.OW' OR ATTACH IOU$-sOPIE51 OF WORK WILL BE COMPLIED W ITH WHETHER SPECIFIED HEREIN <br />r /, f" /n T/C �� OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT /_ SBLOCKZ 2 ,OF 4 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />'T L y OR THE PERFORMANCE OF CONSTRUCTION. <br />DATE <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT <br />IOfl ADDRE / <br />�) / � FY � ` T X <br />F MECHANICAL <br />PLUMBING _c FEE <br />PLUMTYPE E OF EQUIP <br />FEE NO. T <br />NO. TYPE OF FIXTURE 'i' AIR COND. UNITS—H P EA <br />WATER CLOSET QOL IET) i REFRIGERATION UNITS—H P. EA <br />BATHTUB -� II BOILERS —HP EA <br />LAVATORY (WASH BASIN) GAS FIRED A.C. UNI15—TONNAGE EA <br />SHOWER FORCED AIR SYSTEM$—B.T.U. M EA <br />KITCHEN SINK & DISP. _� 4 WALL IiEATE RS—B.T.D <br />DISWASHER UNIT HEATF RS—B.7.0 Ni <br />LAUNDRY TRAY I EVAPORATIVE COOLERS <br />CLOTHES WASHER — aF- b CLOTH[5 DRYERS <br />WATER HEATER. VENTILATION FAN <br />URINAL >• P RANGE HOOD <br />DRINKING FOUNTAIN AIR HANDLING UNIT— C.F M <br />FLOOR DRAIN STOVE. <br />VACUUM BREAKERS MI. TAIL FIREPLACE & CHIMNEY <br />ROOF DRAINS—RAINLEADERS <br />SINK( FRVICE—BAR. TIC) <br />SUBTOTAL S <br />SUB TOTAL �- PERMIT S <br />PERMIT S TOTAL FEE S <br />TOTALFEE $ PLAN CHECK PLAN CHECK NUMBER FEE <br />SI ARD SETBACK STREET SETBACK REAR YARD SETBACK HERECEIPT NO. <br />USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br />OYES ONO <br />BL <br />OCCUPANCY GROUP NO, OF DWELLING UNITS TYPE OF CONST. ISU ILDING <br />MAX. OCC, LOAD <br />SIZE OF BLDG. NO. OF STORIES PLUMBING <br />�'. <br />FIRE ZONE EASEMENT BEDROOMREQUIRED FIRE KLERS MICIfANICAL <br />❑YES [INC) <br />BY DATE OTHER <br />APPROVALS UBC <br />1. ENVIRONME N7AL CHECK LIST <br />I'INALIY SIC 10B.) N! <br />2. BUILDING PLANS TOTAL t�l vl <br />�. <br />J. FIRE HYDRANT PERMIT VALIDATION <br />4, FIRE PROTECTION SYSTEM O'11CN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5. GRADINGILXCAVAI ION & CLLARINGIGRUBBING <br />6. DRAINAGE <br />7 ENVIRONMENTAL IMPACT5IATEMENT <br />B. HEALTH DISTRICT v <br />APPLICATION ACC. BY PLANS CHECKED BY AI'I'R ION 6SUAN(.I BY <br />9 1.79 <br />