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the Evergreen A PPLICATION FOR everett <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-0745 <br />EVERETT, WA9B20T []COMBINATION ❑ BUILDING ❑MECFIANICAL ❑PLUMBING PERMIT NO. <br />OWNER -� MAIL ADDRESS C;TY ZIP PHONE <br />4-:_ I f .o U h L % S ? 7 2 a e.i< v )�, �- Rl Z_C-3 ' 4/ G. S" <br />GENf R/AL�CONT RACTOR/� <br />MAIL ADDRESS <br />�LUjY ZIP <br />PHONE LICENSE <br />�(—! {^' YV'� ✓! <br />7.s 3 i C,4a-L <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE# �--1 <br />1 <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />❑NEW ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />S <br />DESCRIBE WORK / <br />r_ 7 v -) a P a �.f : ` /S — <br />PROPOS SE OF BUIL ING <br />7: a ..� a Y-� a ,TI <br />I <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 AUTHORIZED AGENT DATE of lk 'Z <br />i <br />XNN <br />LEGAL OEIEGAI pE SCRIPT F PROPERTY SHOWN BELOW Oq ATTACH FOUR COPIES) <br />LOT y3 BLOCK_OF .ell <br />, <br />- <br />IOB ADDRESS <br />S3 2 riw� r a <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIET) <br />AIR CONS UNITS —HP EA <br />BATHTUB <br />I <br />REFRIGERATION UNITS—H. P. EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P EA <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS—B T.0 M EA <br />DISWASHER <br />WALL HEATERS—B T.V. M <br />LAUNDRY TRAY <br />UNIT HEATERS —BTU. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />Vf NT ILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.FM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />— PERMIT $ <br />TOTAL FEE <br />S <br />TOTAL FEE S <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 />❑YES ONO <br />FEES <br />VALUATION <br />HE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ <br />J <br />SIZE OF BIDG. <br />NO. OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />T ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 703(a) <br />2 BUILDING PLANS <br />TOTAL <br />1 FIPE HYDRANT <br />4. FILL PROTECTION SYSTEM <br />5 GR.SDINGIf XCAVATION&CLEAR INGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS 15 YOUR PERMIT <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />e. HEALTH DISTRICT <br />APPLICATIUN ACC. BY <br />PLANS CHECKED BY <br />APPEL FOR ISSUANCE BY <br />i <br />9-1-79 <br />Cl <br />