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fheEvergresn AP�LiCATlON F�DR -�� <br />"TM°F ` - CuNSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, wn 9azoi �COMBINATION ❑ BiIILDING <br />❑MECHANICAL ❑PLIIMRINC PFQMIT N(� <br />everen <br />�i <br />� <br />ZIP <br />✓t,-LZ7` Z�/s <br />-_ ._ ____'_._._._.__ ................» ���. ur PNONE LICFNSE• ' �. � � :...�� <br />PIUMBINGCONiqA[t02 MAIL�DDRBS �ITY ZIP PHONF LI[ENSEI �i . . �� <br />CiA550i WORK � � � ; <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR �DFMOUTION ❑FFNCE C�SICN ❑GARAGE ❑OUILDING RELOCATION �� <br />VAtWT/IO�N� Oi WGRK ' <br />� �U✓�, � � � <br />DESCRI9E WORK .. .. . . . <br />VROPOSED VSE Of BNIDING / <br />IELAI OESCRIPTION OF PROPEPiY (SNOWN 8[lOW OR ATT�CN fOUR COPIF51 <br />LOT ,� BLOCK � OF <br />soo s,� o� m �,� <br />�� <br />108 �OOPFSS �� � <br />PLUMBING <br />NO. TYPE OF FI%TUIIE FEE <br />WATER CLOSET (TOI�FT) <br />9ATMTUB <br />UVATORY �WASN BASIN� <br />SHOWER <br />KITCMEN SINK 6 DISP <br />DISWASHER <br />LAUNDRY TRAV <br />CIOTHES WASHER <br />l'UTER HFATER <br />�KINAL <br />DRINKING FOUNTAIN <br />FIOOR ORRIN <br />VACUUM EREAKERS <br />RQOF ORAINS—NAINIEA�ERS <br />SINK (SERVICE—DAR, ETC 1 <br />SU! TOTAI <br />►EIIMIT { <br />TOTAIfFE f <br />IIDEYAND SETBACK $TREETSETBACK REARYFRD SFTAAfK <br />TYPE OF CONST. <br />SIZE OF <br />LOT AREA <br />NO.OFSTOR�ES <br />AP�qOVAl3 <br />L ENVIRONMENTAL CHECK U5T <br />7. 9UIlDIhG PiANS <br />3. RRE MYDRANT <br />�. FIRE P0.0TECTION SYSTEM <br />5 GRADINGE%UVATIONBCLEARINGGNUBBING <br />A �RAIkACE <br />7.E4VIR0{�MENTALIMPACTSTATI'MENT <br />S. MEALTM D�5T0.1CT <br />VACANT S�TE <br />❑YES ❑NO <br />NO. OF DWELI <br />�Y <br />DA7E <br />�PVLICATION ACC. BY p�.�NS CHECKFD BY I APPH FOR ISSUAN�E BY <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- ' <br />PLICATION AND KNOW THE SAME TO 8E TRUE ANU CORRECT ALL � <br />PROVISIONS OF LAW$ AND ORDINANCES GOVERNING THIS TYPE i <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFiED HEREIN � <br />OR NOT. THE CRANTINC OF A PERRAIT DOES NOT PRESUME TO � <br />CIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STAT[ OR LOCAL LAW RECULATING CONSTRUCTION <br />OR THE PERFOR"rv1ANCE OF CONS7RUCTION. <br />SIGNATURE OF CON�RACTOR OR AUTHORIZED AGENT DAtE <br />��/���, ��;�.�. „�,.���o <br />MECHANICAL <br />NO. TY►E OF EQUIPMENT <br />A�H COND. UNITS-HP. EA <br />0.EFRIGFRA710N UNITS-H,P. EA <br />BOIlERS-HP EA <br />C�\5 FlNED AL. UNITS•-TONNAGE EA <br />FORCFD AIR SYSTEMS-B.T.U. M EA <br />WALL HEATERS-B.T.U. M <br />UNIT HFATERS-B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHFS ORYERS <br />VENTILATION FAN <br />RANGEHOOU <br />AIR HANDLI�G UNIT- CF.M. <br />STOVE <br />METAL FIftEPLACE 8 CHIMNEY <br />SUBTOTAL f <br />P[RMIT f <br />NUMBER <br />FEE <br />VAIUATION <br />�L� <br />CIIECK FEE <br />RECEIPT NO. <br />FEE <br />BUILDINC f <br />PLUMBING <br />MECHANIUL <br />OTKER <br />PENALiY U.B.C. <br />SEC. J031a) <br />TOTAI <br />�FIIMIT VAl1�AT1f V <br />WIIEN PROPERLY �.tIDATED tIN THIS SPACE) THIS IS YOUN PERMIT <br />kc` <br />