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the Evergreen A P L I C A T I O, J F O R <br />°'TM OF CONSTRUCTION <br />cveretl <br />everett PERMIT e <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA 4B'o1 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OW ht MAR AUDRI tt Ulv 71P PHONE <br />►�cH yoUsv �r/CT� /YoZ 5.t. �L.er 4Of*U f�%�r�yq <br />ACID 11( I(,R DI SIGNI0. h1All AOORI SS CITY 71P PHONE <br />GINS RAE CONTRACTOR MAIL ADOPT SS I i /,-1—.— T ]IP PHONE LICENSE / <br />_ n _. 1 <br />PHONE <br />PIONIFING('ONIRACpR AAIL ADDIASS !IIY ZIP PHONE L4LENSE4 <br />l I US OF WORK -' II--II�� <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE li IGN ❑GARAGE ❑BUT[ DING RELOCATION <br />S ALUATION Of WORK <br />y oc>� <br />III tt FIRE 1SORK r / <br />►IPYIOE/pr Tr LI A nT <br />rROP,D7cID,v of ni nmv: �F <br />ESGI%I- 540P <br />I HEREBY CFRTIFY 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 Or 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 AUTHOR17-D AGENT DATE <br />IIGM III Sf RII'TION OF PROP) RAY tS11OWN RILOW OR ATTACH FOUR COPIES) <br />u __nlocK_Dr <br />IIHI <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSL i (TOLIET) <br />AIR CONE) UNITS-4 P EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />BOILERS -HP EA <br />LAVATORY (WASH BASIN) <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-B T U AL [A <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRYTRAY <br />UNIT HEATERS-R T U M <br />CLOTHES WASHFR <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANCE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT-C 1 Al <br />VACUUM BREAKERS <br />STOVE <br />0.00F DRAINS-RAINLEADERS <br />Nil TAL FIREPLACE 8 CHIMNEY <br />SINK ISFRVICE -BAR.[ = 1 <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEF S <br />TOTAL FE[ S <br />SIDE YARD SE TRACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMB[R <br />PLAN <br />F11 <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />101 AREA <br />VACANT SITE <br />r7YES DNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLOC <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />III OROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />Il YFS CTNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHI( K LIST <br />PENALTY <br />1,11E <br />S[C tlt yn) <br />7 BUILDING PLANS <br />S FIRE HYDRANT <br />TOTAL <br />FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S CRADINGIf XCAVAIION A Cl IARINGIGRUHHING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />I& ja <br />A FO ISSU t Y <br />91-79 <br />