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L <br />the Evergreen APPLICATION FOR everen <br />GITY OF CONSTRUCTION <br />everett PERMIT <br />DEPT Of COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2548745 <br />EVERETT. WA98201 ❑COMBINATION ❑ BUILDING MECHANICAL -]PLUMBING PERMIT NO. <br />OWNER MAIL ADDX[SS CITY ZIP PHONE <br />%�/�n.><� /Fra et/ 9pj03 is'� -YFoo <br />GENERALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />❑NEW <br />VALUATION Of <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑ FIE NCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />DESCRIBE WORK � D <br />/�iril Tr9+✓ <br />PROPOSED USE OF BUILDING <br />1 REBY 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 />x <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK_ OF <br />108 AOORF SS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIFT) <br />AIR COND UNITS—H P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P EA <br />LAVATORY (WASH BASIN) <br />I <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED A C UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS—B.T U. M EA <br />D15WASHER <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-9 T U M <br />CLOTHES WASHER <br />IVAPORATIVE COOLERS <br />WATER HEATER <br />I CLOTHES DRYERS <br />URINAL <br />VL NTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.FM. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADFRS <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERVICE—BAR. ETC) <br />SUBTOTAL <br />SUBTOTAL S <br />O <br />PERMIT <br />S <br />PERMIT S <br />t7 <br />Q <br />TOTAL FEE <br />S <br />TOTAL TEL S <br />V <br />SIDE YARD SETBACK <br />'.. TRAIT SETBACK <br />REAR YARD SI(HACK <br />PLAN CIIECK NUMBER <br />Pt AN(M <br />ITT <br />EE, It[ <br />RHHEITNo <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES 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 BLDG <br />NO OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BE GROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YE$ ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PI NAI TY <br />U.BC <br />SEC. 31Ra) <br />2. BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />5 GRADING/E XCAVATIONA CLEARINCIGRUBBtNG <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />E HEALTH DISTRICT + <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />!APPRR ISSUANCE BY <br />9-1-79 <br />