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A► .'LIGATION FOR <br />the Evergreen CONSTRUCTIONCITY OF <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA98201 ❑COMBINATION ❑ BUIRDING ❑MECHANICAL ]PLUMBING PERMIT NO. <br />OWNER ♦TAIL ADDRESS CITY A ZIP PHONE n <br />everett <br />ARCHITICT OR DESIGNER <br />MAIL ADURuf <br />�•• - <br />CITY ZIP PHONE LICENSE R <br />Cd IVFRAt CONTRACTOR <br />.,,, AFI ,J .4./ <br />MAIL ADDRESS <br />ii�L�,,R/6 <br />iiLra <br />NICIIANII At CONTRAC <br />PI l'\(PING CONTRACTOR MAIL ADDRESS <br />CItY ZIP PHONE lICf NSF f <br />CI NIS Of WORK �c7 <br />KNEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑❑ISV <br />DEMOLITION FENCE SIGN ❑GARAGE ❑OUILDING RELOCATION <br />N kLL ATIOV OF WORK <br />DI% RIHI WORK <br />G <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSID USE Of BUILDING <br />PLICATION AND KNOW THE SAME TO BF TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />IEGAI DESCRIPTION Of PROPERTY (SHOWN HILDA OR ATTACH FOUR COPY51 <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT _BLOCK —Of <br />VIOLATE OR CANCEL THE PROVISIONS OF <br />GIVE AUTHORITY TO <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />' <br />LOB AODRI SS E VfA•IDTf <br />/*eOZ So. B&OADW SP,ae.c /22 MAGI. <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />AIR UNITS -HP EA <br />WATER CLOSET (TOLIET) <br />REFRIGERATION UNITS -HP EA <br />BATHTUB <br />BOILERS —HP EA <br />LAVATORY IWASII DRAIN) <br />GAS FIRED AC UNITS —TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS —BTU M EA <br />KITCHEN $INK 8 DISP <br />WALE HEATERS —BTU M <br />DISWASHFR <br />UNIT Hf ATERS—BTU M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />_ <br />RANGE HOOD <br />AIR HANDLING UNIT— GEM <br />STOVE <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />f <br />n1FTAl FIREPLACE 8 CHIMNEY <br />ROOF DRAINS—RAINLEADERS <br />SINK(SERVICE —BAR. ETC <br />SUBTOTAL S <br />SUB TOTAL <br />PERMIT S <br />PERMIT <br />S <br />TOTAL FFF S <br />TOTAL <br />SIDE YARD SF TRICK STREET SETBACK <br />$ <br />REAR YARD SETBACK <br />PLAN CHECK FEE <br />PLAN CHECK NUMBER FEE RECEIPT NO. <br />FFE$ VALUATION FEE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />.']YES ONO <br />TYPE Of CONST OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING S Opzs- YtN L� <br />,C. (l V <br />yR� <br />V L <br />SIZE OF BLDG NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE BASEMENT Rf UROOMS <br />RIEQUIREDRE KIfRS <br />MECHANICAL <br />❑YES ❑NO <br />APPROVALS <br />BY DATE <br />OTHER <br />PENALTY <br />U B C <br />SEC 3031.f1 <br />1 ENVIRONMENTAL CHECK LIST <br />2 BUILDING PLANS <br />' 6 <br />TOTAL <br />3 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />�� <br />S GRADINGIEKCAVATION&CLEARINGIGRUBBING <br />6 DRAINAGE <br />jLn7 <br />"" <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />%PP I RA SUANCF <br />—_ <br />J <br />