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r <br />1 <br />L <br />I. <br />L <br />the Evergreen <br />CITY OF <br />!V� <br />i <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT.WA98201 OCOMBINATION J&BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER SAIL ADDRESS I III ZIP PROM <br />EA(' <br />�CNlt7/FG /NG ?/ 5•LAc49Dgwy EUcRCr- <br />ARCHITECT OR DESICNE R MAII ADDRt SS (IIL ZIP PHONE <br />n I 1 5 juF.P t boo �7qs� T1"r Ua ?RQ77 1/8/-7 /.ai <br />GENERAL CONTRACTOR MAIL ADDRESS LM ZIP PHONE LICENSE <br />APPLICATION FOR <br />CONSTRUCTION <br />MECHANICAL CONTRACTOR MAIL ADDRESS IIh ZIP PHONE LICENSE IF <br />PLUMBING CONTRACTOR MAIL ADDRESS I M ZIP PHONE LICENSE R <br />❑NEW ❑ADDITION <br />VALUATION OF WORK <br />DESCRIBE WORK <br />❑ALTERATION ❑RIPA IR ❑OL MOLIT ION { [NCE ZSICN ❑GARAGE ❑BUILDING RELOCATION <br />a n-_� nG G•/_R=O/'/rfc'f Tr rw-✓ /'�RiA%CE/J/s'P <br />/'Ifi/l/L1ti C/L L— ; <br />PROMS[Oust OI BUILDING <br />1 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 OTH,�R STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />, <br />LEGAL DESCRIPTION OF PROPIR1Y(SHOWN BELOW OR ATTACH FOUR COPRSI <br />LOI zg4 BLOCK ,-_OF r ~ <br />108 ADDRESS <br />PLUMBING <br />MECHANICAL (51 <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. U <br />LAVATORY (WASH BASIN) <br />BOILERS—H P. EA <br />SHOWER <br />GAS FIRED A C UNITS —TONNAGE EA <br />KITCHEN SINK A DISV <br />FORCED AIR SYSTEMS —El T U. M EA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRYTRAY <br />UNIT HEATERS —BTU. 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— C F M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC 1 <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTALFEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />III <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONCE <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO Of STORIES <br />MAX DEC. LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE ZONL <br />BASEMENT <br />BL UROOMS <br />FIRE SPRINKLERSRtQU <br />.YFS FIND <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />T ENVIRONMENTAL CHECKLIST <br />PENALTY <br />L LE 11 L <br />S1n 4n1 <br />2 BUILDING PLANS <br />TOTAL <br />B FIR) HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINCAXCAVATION b CLIARINOICRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR IOR ISSUANCE BY <br />W, <br />9.1 79 <br />R Ai <br />