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The Evergreen <br />CITY OF <br />APPLICATION FOR <br />CJRSTRUC TION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑COMBINATION <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />evemn <br />1?14n9J <br />CENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />Alv_f'IZ__ <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE a <br />yt-di'2Q/ <br />PLUMBING CONTRACTOR .MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />❑NEW ❑ADDITION ❑ALTERATION AREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />O6C RE WORK `I' ^•� / <br />PROPOSER USE <br />S� O�F,�SUILDINC �J <br />pri' J�',( <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 ORDINANCFS 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 />x <br />LEGAL Of SCRIPT ION Of PROPERTY (SHOWN BL LOW OR ATTACH FOUK COPIES) <br />22--�� 1 <br />LOT BLOCK of S I -y ib1 a <br />/ / L <br />QctordnL Is,o�rr� f%Td(d n7/ fauYcCt�iH jJo/3 Al�p�,`j .3 <br />4 <br />LOB ADDRESS )' <br />3S /7o r z� <br />PLUMBING <br />MECHANIC <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS —HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE FA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS—B T U MIA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-8 T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEALER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING, FOUNTAIN <br />RANGE HOOD <br />F;OOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINL FACT RS <br />METAL FIREPLACE If CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />SUN TOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <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 CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLOC <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 />NY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U BC <br />SEC 303(a) <br />2 BUILDING PLANS <br />3 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 GRADINGIEXCAVATIOH A CLLARINGIGRUBRING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS [NECKED BY <br />APPR FOR ISSUANCE BY <br />