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tCITY he Evergreen LJNSTRUCTION <br />ev r tt PERMIT <br />DEPT, OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2SM745 <br />EVERETT, WA98201 nrnA4RINATION ❑ BUILDING <br />ANICAL ❑PLUMBING PERMIT NO. <br />ARCHITECT OR DESIGNER <br />^'^" ^•"'^"' <br />CITY <br />ZIP PHONE <br />LICENSE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />F \IE�F ti <br />PEWL1An1D Cc)L\s'C <br />CITY <br />ZIP PHONE <br />LICENSE I <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />RA LEA P2os, <br />1 07 LE4JW_&aY <br />fir <br />4E,97TGE <br />CITY <br />ZIP PHONE <br />IICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CLASS OF WORK <br />%NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE 06UILDING RELOCATION <br />VALUATION OF WORK <br />7ri7.nn <br />DESCRIBE WORK' <br />• I . v I. ! c. \'TT r <br />1 1 GI L L'v`� Tv <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE OFF BUILDING <br />PLICATION AND KNOW THE SAME TO GE TRUE AND CORRECT ALL <br />PoZ�r�l0015 <br />S � (pO <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COMET <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OF <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT _ BLOCK —OF <br />TO VIOLATE OR CANCEL THE PROVISIONS OF <br />GIVE AUTHORITY <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />O—Z — O <br />X <br />JOB ADDRESS <br />�O • v <br />ME HANICAL <br />PLUMBING <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />FCE <br />NO. <br />TYPE OF FIXTURE <br />AIR COND UNITS -HP FA <br />WATER CLOSET (TO' <br />REFRIGERATION UNITS-H.P. EA <br />HATHTUB <br />BOILERS -HP EA <br />LAVATORY (WASH BASIN/ <br />GAS BRED AC. UNITS -TONNAGE EA <br />SHO. EA <br />FORCED AIR SYSTEMS -BTU M EA <br />KITCHEN SINK A DISP <br />WALL HEATERS-BT.U. M <br />DISWASHER <br />UNIT HEATERS —BTU. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />C!OTMES WASHER <br />CLOTHES DRYERS <br />ER <br />VENTILATION FAN <br />RANGE HOOD <br />OUNTAIN <br />AIR I, ANGLING UNIT— C.F.M. <br />IN <br />EAKERS <br />U <br />STOVE <br />FIREPLACE 8 CHIMNEY <br />NS—RAINLEADERSMfTAL <br />CE—BAR, ETC I <br />SUBTOTAL S i� <br />SUBTOTAL <br />YERAIIT B <br />PERMIT f <br />TOTAL FEE B <br />TOTALFEE <br />SIDE YARDS( TBACK STREET SETBACK <br />S <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUA71ON <br />FEE <br />DYES ONO <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NC. 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 />BEDROOMS <br />FIRE REQUIRED SPRINKLERS <br />MECHANICAL <br />oc <br />DYES ONO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />LLB 3 <br />SEC. 303(a) <br />2 BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />A. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATFD (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADING/EXCAVATION A, CLEARINGIGRUBBING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IM'_.T STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BYT PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />, <br />G.C. <br />9.1-79 <br />