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I <br />IRB Evergreen .APPLICATION FOR_ eYePeEe <br />CITY OF CONSTRUCTION Ar, everett PERMIT T <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER -MAIL ADDRESS CITY ZIP PHONE <br />e _ /i/r7l s�N�n/� � 3s9,z,3 <br />ARCHITECT 9K DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE IF <br />MECHANICAL CONTRACTOR <br />MAIL ADCRESS <br />CITY ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADCRESS <br />CITY ZIP <br />PHONE LICE14SE8 <br />G❑WOZK <br />,.,t, ,, <br />NEW❑ADDITION <br />❑ALTERNTION ❑REPAIR <br />&EMOLITION ❑FENCE ❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />f <br />OL SCRIBE WORK' <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I 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 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AU HORIZED AGENT DATE Q <br />� S/9/a <br />x �7 <br />LEGAL DESCRIPTION OF PROPERTY [SHOWN FLOW OR AT A[H FOURCOPIIS) <br />LOT BLOCK_ Of <br />108 ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIET) <br />AIR COND UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED A . UNITS —TONNAGE EA <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS—B T.U. M EA <br />DISWASHER <br />WALL HEATERS-8 T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATET HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.E.4. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLEADERS <br />._ TAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT <br />$1 <br />PERMIT f <br />TOTAL FEE <br />S <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONCE <br />TIES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROJP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BF GROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC, 303(a) <br />2BUILDING PLANS <br />. <br />TOTAL <br />7 FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION L CLEARING/GRUBBING <br />6 DRAINAGl <br />