Laserfiche WebLink
APPLICATION FOR <br />CONSTRUCTIOK <br />PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ]COMBINATION <br />BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />eveTeit <br /><.r PHONE <br />GD(YUAA�Iz OBI tJ 1011 S=I�K�'S �FUaRo1 k J(ARU NONc <br />ARCHITECT OR DESIGNER - MAIL ADDRESS CITY ZIP PHONEJ(oy <br />PLUMBING <br />the Evergreer <br />CITY OF <br />v ulett <br />MAIL ADDRESS <br />P41J <br />ZIP <br />CLASS OF WORK .�Y5 <br />❑NEW ❑ADDITION )']ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />DESCRIBE WORK <br />50loA d- Space rvr iuj-PddletJ 6/36-RAS <br />PROPOSED USE OF BUILDING <br />.— od'Aces <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 O7 HER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THI: PERFORMANCE OF CONSTRUCTION. <br />SIGNATIiP� F CONTRACTOR OR AUTHORIZED AGENT DATE <br />✓ F <br />x - zo-83 <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT _BLOCK_oF <br />02- -UG`12G WA-- <br />108 ADDRESS <br />PLUMBING <br />ML'96ANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND UNITS-H.P. EA <br />BATHTUB <br />REFRIGLNATION UNITS-H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED A . UNITS -TONNAGE EA <br />KITCHEN SINK 6 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-B T.U. M <br />CLOTHE° WASHER <br />EVAPORATIVE COOLERS <br />WATER HFA'LP. <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.FM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS- RAINLE AGE RS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE -BAR ETC <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FLE S <br />TGFAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHEC NUMBER <br />83 i�9/d <br />PLA'. <br />FEE <br />s% <br />CHECK FEE <br />RECEIPT <br />9/0 <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />Y- I PK,Y-N <br />OCCUPANCY GROUP <br />02 <br />NO. OF DWELLING UNITS <br />- <br />BUILDING <br />S <br />J Q / <br />/ <br />,YJ <br />si) <br />SIZE OF BLOC <br />AL:TIz1?A-TL- N <br />NO, OF STORIES <br />MAX OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />^ <br />BEDROOMS <br />-- <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YE$ Niz <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U B C <br />SEC. 303(a) <br />2. BUILDING PLANS <br />1. FIRE HYDRANT <br />TOTAL <br />iJ 0 <br />J•' <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINCIEXCAVATION B CLEARINCICRUBRING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANSILC'HECKED BY <br />I V" <br />APFR FOR ISSUANCE BY <br />A <br />n <br />r <br />9.1.79 <br />j <br />