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■�T r� <br />L <br />L <br />rett INSPECTION REPORT <br />Address -/ 25 S3-_ ?�.., , �ca1t t7 <br />Contractor <br />Owner—, <br />Date <br />`/ <br />TYPE OFINSPECTION REQUESTED <br />/ <br />%LDG: Pmt. No _'QA_2 Q-----❑ MECH: PmL No. <br />❑ ELEC: Pmt. No —❑ PLBG: Pmt. No. <br />❑ Housing <br />❑ Masonry <br />❑ Consultation <br />❑ Groundwork <br />❑ Footing <br />❑ aming <br />rywall/Installation <br />❑ Slab <br />❑ Foundation <br />❑ Spec. Insp. <br />❑ Rough -in <br />❑ Final <br />❑ Wood Stove <br />❑ Service <br />❑ <br />APPROVAL ❑ PARTIAL ANrHUVPLL_ <br />❑ VIOLATION ❑ CORRECTION REQUIRED <br />❑ Corrections listed below MUST BE MADE before work can be approved. <br />❑ Please contact inspector and arrange for appointment. <br />❑ Was not able to perform inspection. <br />❑ CALL 259.8745 FOR REINSPECTION — 24 hour notice required. <br />A CERTIFICATE OF OCCUPANCY SHALL BE ISSUED AND POSTED ON <br />THE PREMISES PRIOR TO OCCUPANCY. <br />Inspector - �e_ Date�A3 <br />I <br />J <br />E. <br />The Evergreen --APPLICATION FOR <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑COMBINATION ❑BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN✓ER- MAIL ADDRESS CITY ZIP PHONE <br />ltlY1C1 Coyw /.Sa 2 es�!/ERS1T{Yl `/L r l? y i�(/ 17� 6✓l¢ (.-Ws 2il MULL) <br />ARCHITECT OR DE51CNER MAIL ADDRESS CITY ZIP PHONE <br />11 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />ATb*PtyAz&*d cd zwr-. O-o. Box s-2G9 /2ie�� e� 'E A. Z-9IVW w�/. gl?e3c 7741 MISS B7RRY/J ZYIGO, <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MAIL ADDRESS <br />CIIY ZIP PHONE <br />CLASS OF WORK � <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑JDEMOLITION ❑FENCE SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />5 6 pO C✓scan brew zw&,7ftL,#rz V) <br />DESCRIBE WORK <br />M"C-C-r C/J S'6"'r Or- ZXlD_LVZ_PdhLf <br />PROPOSED USE OF BUILDING <br />( 0M1 gMc 6W <br />I HEREBY CERTIFY THAT 1 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 />X d/S� �X3 <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT —BLOCK —OF <br />IOB ADDRESS <br />15'452 C-VekCz r Alftf_ c srE <br />PLUMBING <br />MECHA CAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOOLE) <br />AIR COND UNITS—H P EA <br />BATHTUB <br />REFRIGERATION UNITS—H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS ITRED AC UNIT S—TONNAGEEA <br />_ <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS— B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION rAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLE ADE RS <br />METAL FIREPI. ACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />SUBTOTAL <br />SUB TOTAL f <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />S <br />TOTAL FFE $ <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 />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX. OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES FIND <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U.BC. <br />SEC. BD$a) <br />2. BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />a FIRE PROTECTION SYSTEM <br />5 GRADINGIEXCAVATION B CLEARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACI.I HIS IS YOUR PERMIT <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />/ <br />APPR. FOR ISSUANCE BY lI <br />t <br />9 1-79 <br />i <br />