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the Evergreen <br />CITY OF <br />,APPLICATION FOP <br />everett �O"PERMITTI°N <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION <br />OR DESICNFR <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />CITY ZIP <br />OE WRAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />PI UMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WDRK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />S <br />DESCRIBE WORK <br />A �1Z,,�-s O /,-.9A SXaI✓P i��J �S .e�.�0 <br />A <br />PROPOsIDUSE BUILDING <br />LECAL DESCRIPTION Of PROPERTY (SHOWN BELOW OR ATTACH FOUR COPILSI <br />LOT BLOCK _OF <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 <br />e jx ��56' <br />108 ADDRESS- <br />�Y�d �d G <br />PLUMBING <br />ME HANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLLED <br />AIR COND UNITS-H.P EA <br />BATHTUB <br />REFRIGERATION UNITS -HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK IS DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL HEATERS-B.TU M <br />LAUNDRY TRAY <br />UNIT HEATERS-B T U Ni <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CFM. <br />VACUUM BREAKERS <br />STOVE Aonlo <br />'� <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE d CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL <br />SUBTOTAL f <br />--co <br />PERMIT <br />si <br />I <br />PERMIT <br />iq <br />la d <br />TOTAL FEE <br />sl <br />I <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 ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNI15 <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />f1YES ONO <br />MECHANICAL <br />7 <br />S <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHICK LIST <br />PENALTY <br />U.B.C. <br />SEC. MXa) <br />2. BUILDING PLANS <br />TOTAL <br />).FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />S GRADINOIEACAVATION B CLEARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) It IIS 15 OUR PL RMII <br />b. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />I PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />9179 <br />