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Me Evergreen A�yAICATION FOR everl•tt <br />CITY OF CONSTRUCTION <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�/ /� / MAIL ADDRESS CITY /�� �� ZIP PHONE <br />! / /' E/ [e �z� �G'2 V�VGI <br />ARCHITECT OR DCSIGNIR MAIL ADDLE 55 CITY ZIP PHONE <br />G IN I RAI CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE If. ec Y �rCiL3 b/2yz Mi'"cr `j$lc% /vZy-qV3 #04(Co <br />PHIMOWG CONTRACTOR MAIL ADDRESS �esL.r/Le CITY ZIP PHONE LICENSE IF <br />Cl ASS Of WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE SIGN ❑GARAGE ❑BUILDING RELOCATION <br />YALOAIIONOF WORK <br />sro. "= <br />IIIS['NIBI WORK <br />PROPOSID LIST OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AFU <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 ���r.C.O' �V�' ��e ��_' <br />I TUI Of SCRIPHON OF PROPERTY ISHOWN BELON OR ATTAC f FOUR COPHSI <br />ILYI _BIOCK_OF <br />LOB S)DRIss T' V �O• <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />: EE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET HOLIETI <br />AIR CONE' UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS—H P EA <br />I AVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIREDAC UNITS —TONNAGE EA <br />KI7CHEN SINK A UISP <br />FORCED AIR SYSTEMS —BTU M EA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRYTRAY <br />UNIT HEATERS —BTU 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 UNI I— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEA')ERS <br />h11 iAL FINE PLACE 6 CHIMNEY <br />SINK(SERVICE —BAR. ET'"! <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />'PERMIT $ <br />TOTAL FEE <br />S <br />I <br />I <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD S[TRACK <br />PLAN CHECK NUMBER <br />' <br />PLAN <br />FEE <br />CHECK FEE <br />wLCEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT Sit <br />DYES ONO <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 BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />III UROOMS <br />FIRE SPRINKLERSREQUED <br />f7YES F!NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />E ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U IF C <br />IC 70Aa1 <br />2 BUILDING PLANS <br />TOTAL <br />7 FIRE HYDRANT <br />A FIRE PROTECTION S"STIM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />7 — <br />5 GRADINGIIXCAVATION&CLEARINGIGRUBBING <br />L DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />wl <br />W <br />trrg. <br />j� <br />