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the Evergreen L1CATIONFOR rYeF�n <br />CITY OF SP��t I1a CL NSTRUC fy ION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9B201 OCOMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />zo <br />MECHANICAL CONTRACTOR MAIL ADDRL•S CITY ZIP PHONE LICENSE IF <br />PLUMBING CONTRACTOR MAIL ADUY f SS CITY ZIP PHONE LICENSEE <br />CLASS OF WORK � �� <br />bfglW E! ADDITION fE ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />ID <br />DESCRIBE <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO OF 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 DGES 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 PFRFO OF CONSTRUCTION. <br />SICNA f0f CO T C OR AUTHORIZED AGENT DATE <br />v IZ4- / R7 <br />A oc. i / <br />LEGAL DESCRIPTION OF PROPFPTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />/^ 7Ac <br />LOT_BLOCK_OF AlN <br />ppp <br />JOB ADDRESS (�O <br />4 I D S. IPA W n o /1 <br />PLUMBING <br />MECH \ICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />I <br />WATER CLOSET ITOLIETI <br />OCT <br />AIRCOND UNITS-H.P. EA <br />BATHTUB <br />I <br />REFRIGERATION UNITS-H.P EA <br />IF <br />LAVATORY (WASH BASIN) <br />d. <br />OO I <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED A C. UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP <br />'L <br />OO <br />( <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />((A <br />DISWASHER <br />WALL HEATERS-B T U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.TU. M <br />_ <br />WASHER <br />EVAPORATIVE COOLERS <br />_ <br />_CLOTHES <br />VIATER HEATER <br />Soo <br />CLOTHES DRYERS <br />URINAL <br />' <br />VENTILATION FAN <br />CjO <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CF M <br />LV <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLFADE RS <br />METAL FIREPLACE A CHIMVEY <br />SINK (SERVICE -BAR. ETC 1 <br />sob <br />SUBTOTAL <br />L <br />SUBTOTAL f <br />�— <br />PERMIT <br />f <br />PERMIT f <br />FOTAL FEE <br />f <br />L <br />I90 <br />TOTAL FEE IT <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />W eOSV <br />PLAT/ <br />FEE '93. IRECEIPT <br />CHECK FEE <br />NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES �NO <br />FEES <br />VALUATION <br />FEE "—" <br />TYPE OF CONST <br />/ FF _' /J <br />OCCUPANCY GROUP <br />f3Z � <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />0 '7 C �' <br />00 <br />512E OF BLD; <br />FIRE ZONE <br />NO. OF STORIES <br />BASEMENT BEDROOMS <br />MAX C.CC oLOAD <br />ell <br />FIRE SPRINKLERS <br />RE UIRED <br />ES ONO <br />PLUMBINGi <br />MECHANICAL <br />., <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC T0T(a) <br />2. BUILDING PLANS <br />TOTAL <br />-� G7 I <br />oo <br />B FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 GRADINGIEXCAVATION& CLF A;I IGICRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />I/ C r <br />AYPR. FOR ISSUANCE BY <br />