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',PPLICATION FO^ everen <br /> Me Evergreen C O N ST R U CT 1 O N e <br /> CITY oP <br /> everett PERMIT <br /> DEPT OF COMMI'NITY DEVELOPMENT SERVICES <br /> CITY HALL 259�8745 <br /> EVERETT.WA98201 ��OMBINATION BUILDING ❑MECHANICAL ❑PLUMBING PERMITN . <br /> ' OWNlX MAIIAp N[SS ❑TY ZIP PHONF <br /> t/� / 1Jzi-)�o vvn ) '� 3 ) �-o � 6� r� �yL�ZiT 9 �iao1 �5� 3g�7 <br /> I' 1 R r^ � n CIiY ZIP PNONE <br /> eRO11ifR OR��SIGnla blell ADDRE55 <br /> L(NFPALCOYINACiOR Q W Y1 �' Y <br /> MAII ApDRE55 UTY ZIP PNOMF UCENSf t <br /> �� L � I <br /> s /P r /�G �° V—�n [�p rNorv[ l�c[NS[r <br /> .��f CHAAIUI CONLR�QOR <br /> nqll ADORF55 ���Y <br /> ��T� Z�p PNONE IICENSE� <br /> PIUMIII�LCONINnCLOP MnILADD0.E55 <br /> C1�15 OL NOHN <br /> ❑NEW ❑ADDITION �LTERATION ❑REPAIR ❑DE.�IOLITION ❑FENCE ❑SIGN ❑GARAGE UUILDING RELOCATION <br /> X;`l�'�"��o Ro <br /> ,oyscHinF woaK � _ <br /> �� <br /> .�revosio uzi or nwioi c I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH15 AP- <br /> �� � ` PLICATION AND KNOIV THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> � uyn106CR1V110 O�PROP[MIYISIIOWN 9[LOW OR.VTACHfOURCOPIf51 OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> X ��{-�j-l(o �$ � � �u; o�.�.,d A�c�.il OR NOT. THE GRAN"IING OF A PERMIT DOES NOT PRESUME TO <br /> 'ibT���flIOCK OF <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORINANCE OF CONSTRUCTION p �{ <br /> SIGNATURE Of CONTRACTOft OR AUTHORIZED AGENT�� DATE / " I � � �7 I <br /> ��^ya3s Lo X "7 � <br /> MECHANICAI <br /> PLUMBING FEE <br /> NO. <br /> TYPE OF FI%TURE FEE NO. TYPE OF EQUIPMENT <br /> AIF COND UNITS—H P EA <br /> WATER CLOSET ITOIiETI <br /> HEFRIGBATION UNITS—HP EA <br /> OATHTUB <br /> [iOIlERS—��.P EA <br /> LAVATORV(WASH 6ASIN) <br /> GAS FIRfO AC.UNITS—iONNAGE EA <br /> SHOWER <br /> FORCED/IR SYSTEMS—P T U M EA <br /> KITCNEN SINK&OISP <br /> \yqLL HEATERS-6T U M <br /> DISW�SMtR <br /> U��ITHEATERS—I1TU M <br /> UUNDNY iRAY <br /> FVAPORATIVE COOLERS <br /> CLOIHES\YASHER �LOTHES DRVERS <br /> WA7fN MEATEN <br /> VEN7ILATION FAN <br /> UHINAL <br /> RANGEMOOD <br /> ORINKINC fOUNTAIN <br /> AIR HANOLING UNIT— C F M. <br /> fIOON DRAIN $TOVE <br /> VACUUM OREAKERS <br /> METAL FIREPUCE d CHIMNEY <br /> ROOF DRAINS—R�INIEADERS <br /> SINK(SERVICE—f1Ah, ETC 1 <br /> SUB TOTAI S <br /> SUB TOTAI PERMIT s <br /> ^ERMIT S 3 <br /> S 70TA1 FEE <br /> — TOTAI FEE p��N CHECK FEE <br /> SID[ YARD SLTOAIX STREE7 SETpACK REAR YARD$RUACK PLAN CNECK NUb18ER FEE RFCEIPT NO. <br /> USE ZONE lOT AREA y�[�NT SRE FEES VAlUAT10N iEE <br /> ❑YFS ❑NO <br /> TVPE OF CONSf OCCUPANCV LROUP NO OF�WELIING UNI75 <br /> 6WLOING s <br /> SIZ[ OF OIOG NO OF STORIfS MA% OCC IOAI) <br /> PWMOING <br /> ��H� Zpry� NASEMENT 11fUR00.�15 KEQUIRE'OKLENS �,�ECMANIGL <br /> flYfS C�INO <br /> APPNOVAlS 9Y DATE OTMER <br /> 1 ENVIRONMENiALCHEIXl15T U.BC. <br /> FENAITY SEC I011a) <br /> I OUILOING VUNS l �. /'/�' 3 7�T�i <br /> J FlNF MYDRANT � � <br /> PERMIT VALIDATION � <br /> i FINkPRO1KTION5Y5TEM WHENPROPERLYVAlID�1ED11NT11155PACE1THI515Y0URYERMIT <br /> 5 GHADINGtXUV�TION6QFARINGIGRUN8ING �., <br /> 6 ORAINAGE <br /> 7 E�NIRONMENTP.I IMPACT$TATEMENT <br /> 8 HFAITM DISTRICT <br /> ApPLICATION ACC BV P A 'CME �D BY APPR FOR ISSUANCE 9Y <br /> � %, '� . <br /> e-�-��, <br /> i _ <br /> I <br />