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the Evergreen <br />CITY OF <br />APPLICATION FOR <br />everett CJNSTRUCTION <br />PERMIT <br />DEFT OF COMMUNITY VEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA 98201 OCOMBINATION <br />MAIL <br />m <br />❑ BUILDING ❑MECHP.NICAL ❑PLUMBING PERMIT NO. <br />CITY <br />L <br />55%21�'dai-nc-vc-zA,ry <br />PHONE LICENSE r <br />PHONI LICENSE P <br />;1n / - /as-Nc IJx ) /• (S"N 11", /N L7LI Of, "S ,i lb' 1; /R1 rC � L <br />CLASS Of KORK <br />❑NEW ❑P.DDITION ❑ALTERATION fidREPAIR []DEMOLITION ❑FE14CE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WOKK <br />a 4/)0/)i, gon <br />DESCRIBE WORK _ _ _ /J . / aK ia,n aj"AF 4nd <br />USE QE BUILDING <br />LEGAL DISCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH 1r <br />FOUR COPIISI <br />LOT � BLOCK _1OF t r x )I /`7l/i / A <br />108 ADDRESS <br />HEREBY CEh Y 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 OFFCCONTRAC. TORORAUTHORIZED <br />/AGENT DATE <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />/ <br />WATER CLOSET (TOLIET) _ <br />'1 <br />n0 <br />AIR COND UNITS—H P EA <br />BATHTUB <br />REFRIGERATION UNITS-11P EA <br />BOILERS —HP EA <br />LAVATORY (WASH BASIN) <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />,r <br />00 <br />FORCED AIR SYSTEMS-BT U MIA <br />DISWASHER <br />WALL HEATERS -BTU M <br />I AUNDRY TRAY <br />UNIT HEATERS -BTU M <br />CLOTHES WASHER <br />O <br />1VAPORATIVE COOLERS <br />WATER HEATER <br />'P <br />_ <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />_ <br />METAL FIREPLACE 6 CHIMNEY <br />SINK 15FRVICE—BAR. ETC; <br />SUBTOTAL <br />_ <br />C <br />_ <br />SUBTOTAL s <br />PERMIT s <br />PERMIT IF <br />TOTAL FEE $ <br />pv <br />TOTAL FEE IF <br />SIDE YARD SETBACK <br />- <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />!'LAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />�,A <br />7 S' <br />SIZE Of BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />06 <br />FIRE ZONE <br />BASEMENT <br />81DROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />9YES MIND <br />MECHANICAL <br />APPROVALS <br />SIT <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC lORal <br />7 BUILDING PLANS <br />S FIRE HYDRANT <br />TOTAL <br />1,11 <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINCIf KCAVATION6 ClEARINGIGRUBflING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />