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G4� <br />The Evergreen A► AICATION FOR <br />everett OF CONSTRUCTION 93111rZ DEPi OF COMMUNITY DEVELOPMENT SERVICES PERMIT <br />CITY HALL 259-8745 <br />EVERETWA98201 EL <br />ElBUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS <br />� � ^ CITY ZIP PHONE <br />""""..I. —1 <br />MAIL ADDRESS <br />CI Y <br />ZIP <br />PHONE <br />GINFRAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE( <br />�� n� il/ . <br />�i /L�n c i✓�/16�^` tl <br />SR CHenrt AE CONTRACTOR <br />Mql AD00.f 55 <br />.,, .� <br />❑TY <br />3fc�� <br />ZIP <br />Alp <br />PHONE <br />LI[F n5[• <br />PI l'sIBA(: CONTRA[ TOR <br />MAIL ADDRISS <br />CITY <br />ZIP <br />PHONE <br />DCENSE0 <br />XNEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE IAVSIGN ❑GARAGE ❑BUILDING RELOCATION <br />\ All ATION OF WORK <br />III I( FIRE WORK <br />19 / <br />PROPOSID t M 01 BUILDING <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 OTHER STATE OR LOCAL. LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />ILGAL DISCRIPTION OF PROPERTY (SHOWN BILOW OR ATTACH FOUR COP1151 <br />LOT __RtOCK_OF <br />"s ADDRI ss EVCA.EE7i <br />/4".0 Z So • 73A_e,AOUJ SPA-r G / 2 2 MALL <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIET) <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS—H P EA <br />LAVATORY ("ASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK 6 DISP <br />FORCED AIR SYSTEMS —B T U M EA <br />DISWASHER <br />j <br />WALL HEATERS-B T U Al <br />LAUNDRY TRAY <br />UNIT HEATERS-8 T U 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- CFM. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEAOERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC) <br />SUR TOTAL <br />SJB TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />SIDE YARD 51 TRACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FIE <br />CHECK FEE <br />I RECEIPT NO. <br />JSE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />SYJC"7Ffo <br />AF` <br />IS- <br />Vn0 <br />SIZE OF SLOG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />HF )ROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />CIYfS ONCE <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC. <br />SEC. 307(a) <br />2 BUILDING PLANS <br />7 FIRE HYDRANT <br />TOTAL <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLYVALIDATED(IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADING/f %C'AVATIONB CLf ARINGIGRUIiI, r.., <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />E HEALTH DISTRICT <br />APPLICATION ACE: BY <br />PLANS CHECKED BY <br />APP F 5_SL�ANCk <br />/ �((JJJj <br />91.79 <br />