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AP` LICATION FOR OF Cl" <br />Evergreen <br />OILY CONSTRUCTION <br />O <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILD.NG ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />ZIP PHONE <br />OWNER MAIL ADDRESS CITY ' <br />�J�lGUD�! ,4 &e/ /q7n �I40/cn�/ Ff/�Y1E7T <br />ARCH17ICT OR DESICNIR MAIL ADDRESS CITY 21P PHONE <br />LICENSE R <br />GENERAL CONTRACTOR MAIL ADDRESS CITY 21P PHONE <br />.S1G/V/TF S/lit/ / 30/uk LICENSE IF <br />S,o.9�lE ✓NyoaO 3L53.9y z��3 <br />-- MML ADDRESS C 1 LIP PHONE <br />SIICHAN'ICAL CONTRACTOR <br />PIDSIB6L CONTRACT MAIL ADDRESS <br />City ZIP PHONE lICf NSE E <br />(I ASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION IIFENCE SIGN ❑GARAGE CIBUILDINGRELOrATION <br />1wtt-MION Of WORK <br />T vo <br />I)[SI KIHI WORK rin wh �a�T�// <br />PRPPOSID D51 Of BUILDING I 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- . <br />ME TO BE TRUE AND CORRECT ALL v <br />LICAL DISCRIPtION OF PROPERTY [SHOWN BELOW OR ATTACH FOUR COPIES) <br />I'll _BLOCK —OF <br />I1111 SDORISI <br />USE <br />OF <br />FIRE <br />SHOWER <br />KITCHEN SINK DISP <br />D15WASHFR <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS —RAINLEADE AS <br />SINK (SERVICE —OAR. ETC) <br />SUBTOTAL <br />PERMIT s <br />YnY.l PFF s <br />AREA <br />MENT <br />APPROVAL$ <br />1 ENVIRONMENTAL CHECK LIST <br />2 BUILDING PLANS <br />1 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />S GRADINGIIKOYVAIIONACLEARIP'GIGRUBBING <br />6 E'AINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />.PPOCATInN ACC. BY r PPL&bL4 Cf1ECKEE <br />BY <br />VACANT SITE <br />OYES CNO <br />BY <br />FOR <br />PLICATION AND KNOW THE SA <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE 4 <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE <br />T PRESUME TO <br />GIVE AUTHORITY ATOIDOES O <br />VIOLATE OR CANCEL THEPROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION ; <br />OR THE PERFORMANCE OF CONSTRUCTION. '/�Z��O <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE N .ie✓s <br />EICAL <br />TYPE OF EQUIPMENT <br />AIR COND UNITS—H P EA <br />R IGERATION UNIT'— IF P. EA <br />BOIL —HP EA <br />(,AS FIRE AC UNITS —TONNAGE EA <br />FORCED AI YSTEMS—B.TU h <br />WALL HEATER BTU. M <br />UNIT HEATERS-9 U M <br />EVAPORATIVE COOL <br />RANGE HOOD <br />AIR HANDLING UNIT — <br />STOVE <br />'BACK <br />PLAN CHLLK n <br />1 <br />NG UNITS <br />BUILDING <br />ID <br />PLUFABING <br />AS <br />MECHANICAL <br />DATE <br />OTHTR <br />PENALTY <br />BY <br />s <br />-- PLAN CHECK FEE <br />FEE I RECEIPT NO. <br />P <br />TOTAL <br />PERMIT VALIDATION <br />WHIN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />9-1-79 <br />L. <br />