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�` PPLICATION FOR e�e,en <br />theEvergreen CONSTRUCTfON �� e <br />CITV OF <br />everett PE RM IT <br />DEPT. OF COMMUNITV DEVELOPMENT $ERVICE$ <br />CITY HALL 259�8745 <br />EVERETT, WA98201 �COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />!O]W�N�kH � MAIIAGDM65 .UiY 21P PMONE <br />� uGll�S 1 r-✓�J7� 24�F-:� ��� ��.�c'i�i�4h"� �1 - <br />�RCMITECT OR OESIGRfR M�II �OOHF55 CITY ZIP () PHONE 7 <br />�j1U��C)��(clJLC.S/'� Z���� {Lil1t�C. �� `"1Di6V ZCi?''uJdyr SIN�GOSGZl�.P7 <br />GFNFR�ICONipnfi00. MAlln0URF55 CILY 21P PHONE /iCE SE� <br />M(CHANIUICONTHACION MAILAODRE55 C�iY LIP PHONE IICENSfM <br />PlUAl01nL CONTR,1CiOR Mell �DOR65 CIiY ZIP PHONE IICENSE 1 <br />:1A550F WORK �,� <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE V151GN ❑GARAGE ❑BUILDING RELOCATION <br />VnIUAiION OF WONK <br />f� C�I <br />DESCRIBE �YORN <br />PNOPOS[D USF OL flULL01rvG <br />IEWI DESCPIPTIOv Of PROPFfttY ISIIOWN 9FLOw OR ettACM fOUR COPIf51 <br />lOi _� BIOCK _� �F <br />ioe nooa�ss <br />PLUMBING <br />Np, TYPE OF FSwNRE <br />WnTER CLOSET ITOLIETI <br />EfATHTUO <br />UVATORV (�:'�5�1 �ASIN� <br />$HOWFR <br />KITCHEN SINK d DISP <br />DISWASHEH <br />LAUNORY TRAY <br />CLOTMES\VASHFK <br />\YA7ER HEAiER <br />URINAL <br />URINKING fOUNTAIN <br />FLOOR �RAIN <br />VACW�1 [IftEAKERS <br />ROOF DkAINS—kA�NLEADEHS <br />SINK �SERVICE—B�R, ETC! <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />SIDC YARD SE16�CK STREET SETIIACK <br />nce �nuc l0T AREA <br />7YPE G� ZONF. OG <br />SITE OF 6LUG NO <br />FlRCZONE ��� <br />GROUP <br />IES <br />Ilf DNOO.NS <br />APPNOVALS <br />1 ENVIRONMENiAL CHECK LIST <br />3. BUILDING PLANS <br />7 FIRE Y.YDRANT <br />< FIRE PROTECTION SYSTEM1I <br />5 CRA�WGIL%U\'ATION6QEAHINCIGRUHBINC <br />6 DRAINACE <br />7 ENVIRONMFN7Al �MPACT STATE�IENT <br />B MFnITM OISTRICT <br />APPIIUIION ACC OV �IAN$�ECI:FAO <br />FEE <br />�S <br />RUR VnRD $ETO <br />VAGNT SIiE <br />❑YES Cn0 <br />NO OV DWFLLIN� <br />MA% OCC LOA� <br />BY <br />OY � APPN iOR <br />DATE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE �ND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WNETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOE$ 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 CONT PfOR OR AUTHORIZED AGFNT DATE <br />_. �!i`/ 1 � / ( � lY� <br />�IGAL <br />TYPE OF EQUIPMENT <br />AIR CONU UNIiS—H P EA <br />REFNIGERATION UNITS—N p, EA <br />BOIlENS—H P EA <br />GA$ FlRED nC UNIT$—TONNAGE EA <br />FORCCD AIN SVSTEMS—[iS.U. M EA <br />IVALLHEAiEHS—�iL. M <br />UNIT HkATERS—[1 T U. M <br />EVAPORATIVE COOLEftS <br />ClO7HE5 DRYEfti <br />VENTILATION FAN <br />RANCFHOOD <br />AIR HANOLING UNR— C.F M. <br />STOVE <br />METAI FlHEPUCf 8 CHIMNFY <br />�SUBTOTAI ' — <br />PERMIT s <br />TOTAI FEE f <br />PLnN CHCIX NU.'.111fR PLAN CHKK FFE <br />FhE I RKEIPTNO. <br />""". vuu�nnN fEf <br />I3UIlUING s <br />VLUMPING <br />MlCHANIUI <br />OTHER <br />UIlC <br />Pt NALiY SEC. 30Jfa) <br />TOT/.l <br />PEAMIT VALIUATION <br />WMEN PkOPERLY VAUDATED ON THIS SPACEI 1HIS IS YOUR PERMIT <br />�� Z�f-�( � <br />l � � ', ���(,'� l_"(L' ��(:L,�'L�" <br />� 1�- ( . <br />