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NB Evergreen <br />APPLICATION F O R!YlTOn <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT <br />SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA 98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER^ /� <br />MAIL ADDRESS CITY ZIP PHONE <br />1\TAPJ1i A5Soc1AT-G <br />—I402 SE FL)ER�r MAELWAV E�YEQEZT Q&206 355-54d4 <br />ARCH!TECI OR DESIGNfR <br />1 <br />MAIL ADDRESS CITY ZIP PHONE <br />t�I � A <br />GEMRALCONT AC*OR <br />MAIL ADDRESS CITY Z., PHONE LICENSE IF <br />T-rxwt A <br />—�402 SE FSRE� L1AAL1 t�AV �F�Ecsrr g8zo4 ass—s444 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY LIP PHONE LICENSE <br />N/A <br />PlIMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE LICENSE <br />141A <br />CLASS OF WORK <br />❑NEW ❑ADDITION <br />®ALTERATION []REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE El BUILDING RELOCATION <br />VALUATION OF WORK <br />3o0o.p0 <br />DESCRIBE <br />/WORK <br />l us,TAI I <br />T Y� �,L �L <br />�I c S'VA I�::�2G,:�V STQL:"E-L:CY IiJ� <-1QAIAEAS IY AP-toti <br />L <br />PROPOSED VSF OF BUILDING <br />S <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 ORDDANCES 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 />IF AUTHORIZED AGENT DATE <br />SIGNAT=4w-r--t, <br />X <br />LEGAL OF SCRIPT ION OF PROPERTY (SHOWN BELOW OR ATTACH I OUR COPIES( <br />LOT _BLOCK_OF <br />108 ADDRESS A <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />VcAT[ R CLOSET (TOLIET) <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS-B.T U. M EA <br />DISWASHER <br />WALL HEATERS-B.7 U. M <br />I. AUNDRY TRAY <br />UNIT HEATERS-B.T.V. 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 UNIT- C F.M. <br />VACUUM BREAKER'{ <br />STOVE <br />ROOF DRAINS-RAIhL'ADFRS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC 1 <br />SUBTOTAL <br />I <br />SUBTOTAL 3 <br />PERMIT <br />$1 <br />PERMIT f <br />TOTAL FEE <br />3 <br />TOTAL FEE 3 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF'.-ONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />Sze <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASFMFNT <br />NLDROONIS <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ❑ND <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U.B.C. <br />SEC. 10Xa) <br />Z BUILDING PLANS <br />TOTAL <br />_ <br />-�C- <br />7 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED UN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION & CLEARINGIGRUBRIND <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR )F OR ISSUANC 'BY <br />A . �,. <br />9.1-79 <br />