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r <br />the Evergreen APPLICATION F ( RCITY OF <br />everetT <br />everett Ck-NPERM TTION <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION BUILDING ❑MECHANICAL ❑PIIIMRWG PERMIT Nn <br />GENERAL CONTRACI00. MAIL ADDRESS[ C E C17Y ZIP PHONE LICENSE <br />--------- ­ I ur rnum LICENSEE <br />PI UMBING CONTRACTOR A 11 ADDRISS CITY ZIP PHONE LICENSE It <br />CLASS OF WORK <br />❑NEW ❑ADDITION ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALWTION Oi WORK <br />256 00 <br />Db[pBE wORK <br />T A <br />PROPOSED USE Of BUILDING <br />Lk t104- <br />I HEREBY CiRTIFY 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 HORIZED AGENT DATE <br />X � <br />LICAI DESCRIPTION O{ PROPERTY (SHOWN BELO OR AIiACN {OUR COP A <br />w7 �� 2(o aLocK OF 6'?A <br />1 2S <br />JB AODRL SS � <br />1 <br />PLUMBING <br />MECHANEC L <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />SA' AIIR CLOSET(TOLIF TI <br />AIR CONE) UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS-11 P EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />CAS FIRED A C UNITS —TONNAGE EA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS—B.T U. M EA <br />— <br />DISWASHER <br />WALL HEATERS-8 T U M <br />LAUNDRY 7RAY <br />UNIT HEATERS—B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I LOOR DRAIN <br />AIR HANDLING UNIT— CFM <br />VACUUM BREAKERS <br />S70V1 <br />ROOF DRAINS — RAIN[ [AGE RS <br />METAL FIREPLACE b CHIMNEY <br />SINK (SERVICE —BAR. ETC I <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />P[PMIT 3 <br />TOTAL FEE S <br />TOTAL RE 3 <br />SIDE YARDS[ TRACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />1a 73 7 <br />PLAN CHECK IIF <br />FEE RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />it1 <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING 7NI75 <br />BUILDING <br />S 4.— <br />So <br />�O <br />UU <br />SIZE Of BLDG <br />NO Of STORIES <br />MAX O[C LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />i ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC. <br />SEC JOXRI <br />2 BUILDING PLANS <br />B FIRE HYDRANT <br />TOTAL <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINCII XCAVATION B CLIARINCIGRUBBINC <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT, <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR [OR ISSUANII fPl <br />9-i-79 <br />