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the Evergreen A o P L I CATION FOR <br />CITY OF CONSTRUCTION e <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA 98201 COMBINATION ❑ BUILDING CMECHANICAL PLUMBING PERMIT NO. <br />OWNER MAIL AUURf55 III ZIP PHONE 34.2-dFy3 i 3 <br />ovv/t A. /c/EvC� (3u5" r=r2u+nuo P[. E✓&72 iT %Y,1o:3 <br />MAIL <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IT <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />CLASS OF WORK <br />ONEW ADDITION ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE. ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />S_ <br />DESCRIBE WORK 'vDDi 7-/6-I% car SOC P/2 (%OL e C.= _i e?S /q'uJ .�C-T/_0��7 OF c.L'$7id%G liC: cc�iOTC•Y' <br />PROPOSED USE UI BUILDING <br />'Fe725o,F/Fi C 22E3iDE-aIJCC <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT _BLOCK_Of <br />- <br />IOU ADDRESS <br />[o i0 i� /-//luhY.'JD PC. Co lac: X3r T/ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIETI <br />AIR COND UNITS-H P EA <br />BATHTUB <br />REFRIGERATION UNITS --HP EA <br />LAVATORY (WASH BASIN) <br />HOILERS-H P LA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK B 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- IF T U M <br />CLOTHES `A'ASHER <br />EVAPORATIVE COOLERS <br />WATER HEATLR <br />CLOTHES DRYERS <br />URINAL <br />�` <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT F M <br />VACUUM BREAKERS <br />S70VE <br />ROOF DRAINS - RAINLEADERS <br />MFTAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR. ETC) <br />SUB TOTAL <br />B-cl <br />SUN TOTAL IF <br />PERMIT <br />S <br />PERMIT B <br />TOTALFEE <br />S <br />c) <br />TOTAL FEE B <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBIR <br />PLAN <br />FEk <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE . L <br />_I <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />s <br />SIZE OF HLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />rj <br />C <br />FIRE ZONE <br />BASEMENT <br />If LDROOMS <br />REQUIRED FIRE INKLF SPRINKLERS <br />F7YF5 ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALLY <br />UBC <br />SEC JOJ(a) <br />2 BUILDING PI ANS <br />TOTAL <br />J FIRE HYDRANT <br />SYSTEM <br />A FIRE PROTECTION SYSTEM <br />-- <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGILXCAVATION A CLEARINGIGRUBHING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR/ FOR ISSUANCE BY <br />OF <br />b- 9-1 79 <br />