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the Evergreen <br />CITY OF <br />APPLICATION FOR.- <br />.;ONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA 9B201 XCOMBINATION <br />❑ BUILDING <br />❑ MECHANICAL <br />❑PLUMBING PERMIT NO. <br />OWNER <br />' LEG?CcA7 <br />MAIL ADDRESS <br />3`LA'Yo <br />"% <br />4Va <br />.'0 <br />/;'qT <br />AIAII ADORLSS <br />CRY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />SHon <br />ZIP <br />'/Bo�7 <br />PHONE LICENSE r <br />337-33s7 C9StC 17Y: <br />CAym- CON 1,%jc• <br />yr%`/7 1-7o1H 5, <br />_rm <br />CITY <br />ZIP <br />PHONE LICENSE F <br />MECHANIULCONTRACSOR <br />MAIL ADDRESS <br />PLUMBING CON'IRAC'OR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE r <br />QW A/C 2 <br />CLASS OF WORK ttcc�5�1 <br />REPAIR <br />[]DEMOLITION ❑FENCE <br />❑ SIGN <br />❑GARAGE EIBUILDING RELOCATION <br />❑NEW ❑ADDITION NA <br />Fa <br />VALUATION OI WORK <br />EGo , <br />DESCRIBE WORK <br />IzEA+oot=L- MEw FooArorETFOV c ,3!Srmc. r <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE OF BUILDING <br />I HEREBY <br />TO BE TRUE AND CORRECT ALL <br />3'rA>6W FAMFcy 2c5rgGJGt <br />PLICATION AND KNOW THE SAME <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />LEGAL DESCRIPTION Or PROPERLY (SHOWN BELOW OR ATTACH TOUR COPIES) <br />! _ <br />'%sO 9LOCK 81 F3 PL E" r <br />OF <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT of <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />AS /La GO /LO L= h r.� (/o' c/ /�L v7 i %���� 23 <br />ANY OTHER <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />SrvoNeF�F+rrrl G_t�A.�`• wr9 <br />IOB ADDRESS <br />/ L .a <2 ALI if i -R r <br />A <br />MECHANICA <br />PLUMBING <br />NO. <br />TYPE OF EQUIPMENT <br />AIR COND UNITS-H P EA <br />FEE <br />Np, <br />TYPE OF FIXTURE <br />FEE <br />CO <br />CLOSET ITOLIET) <br />�D <br />REFRIGERATION UNITS-M.P EA <br />BATHTUBWATER <br />GG <br />BOILERS -HP. EA <br />'r <br />LAVATORY (WASH BASIN) <br />GAS FIRED A UNITS -TONNAGE EA <br />SHOWER <br />Od <br />FORCED AIR SYSTEMS-B.T U M EA <br />KITCHEN SINK A DISP <br />0 <br />WALL HEATERS—B.T.U. M <br />OISWASHER <br />UNIT HEATERS—B.T U. M <br />LAUNDRY TRAY <br />Q <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />1 <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE MOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F M. <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE 6 CHIMNEY <br />ROOF DRAINS -RAINLEADERS <br />SINK (SERVICE -BAR. ETC) <br />%. DO SUB TOTAL f O <br />SUB TOTAL <br />PERMIT $ <br />PERMIT <br />S S QQ <br />S OO TOTALFEE <br />TOTAL FEE <br />REAR <br />YARDS TBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />SIDE YARD SETBACK STREET SETBACK <br />FEE RE EIPT NO. <br />9-31 /,P- 3F <br />VACANT SITE FEES VALUATION FEE <br />USE ZONE <br />LOT AREA <br />❑YES UN2 <br />OF DWELLING UNITS/ <br />S <br />TYPE OF CON <br />OCCUPANCY G OUP NO <br />BUILDING <br />MAX OCC LOAD <br />00 <br />SIZE OF BLDG <br />NO OF STORIES <br />PLUMBING pt <br />REQUIRED RE PNKLERS MECHANICAL OZ <br />FIRE ZONE BASEMENT BEDROOMS <br />nYFS CTNO <br />APPROVALS <br />BY DATE OTHER <br />1 ENVIRONMENTAL CHECKLIST <br />U.B.0 <br />PENALTY . <br />SEC. TOHaI <br />2 BUILDING PLANS <br />TOTAL <br />7 FIRE HYDRANT <br />a FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATIONBCLEARINGIGRUBRING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKE711yAPPR,,,1OR <br />ISSUANCE BY <br />. toI. <br />9 1-79 <br />