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k_. <br />APPLICATION FOR eFeN <br />the <br />CITY OF Evergreen <br />: O N S T R U C T I O N Pi <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELORMF N1 SLRVICLS <br />CITY HALL 259-8745 <br />EVERETT. WA98201 COMBINATION El BUILDING ]MECHANICAL ❑PlUM81NG PERMIT NO. + <br />oSY tR // �� �CI n1�AD/:'1/ � .• ..-an � zlr PHONI�_�^ J 1 <br />CITY <br />CI I�ONTRACF/OR <br />�'l' s' /2JA / sanxT L/e <br />NIC14ANICAL CONTRACTOR <br />MAIL ADDRESS / <br />/�%�-� Y <br />MAIL ADDRESS <br />�� s F�c✓� <br />Ir-Div <br />�J,LC/r�`n <br />CITY <br />21P <br />c,4 �l2 rZ%�iJ <br />11P <br />YHUNt <br />/ �5' <br />PHONE <br />a Iv4 iC <br />UCL SfI <br />IICENSf0 <br />PLUMBING. CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CLASS <br />❑NEWWDRK❑ADDITION IOALTERATION LJ'RE PAIR ❑DEMOLITION ❑FENCE ❑SIGN Va RAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />f <br />OISCRIBF ORK <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROWSID USL of Bm[o ND <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 />ISI <br />WIDISCRIPUON OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COME <br />LEGAL <br />y4lb OF l F <br />.• <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LDt BLOCK <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULAI ING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION, <br />SIGNAT Of CONTRACTOR OR AUTHORIZED AGENT TE <br />V � <br />LOB AOD0.FS5� <br />�•ii�•tY// / .Cu E-K6T/• <br />A <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />O. <br />TYPE OF FIXTURE <br />WATER CLOSET (IOLIF7) <br />AIR COND UNITS-fl P [A <br />RFFRIGFnAIQNUNIIS-HP [A <br />BATHTUB <br />BOILERS -HP EA <br />LAVATORY IWASH BASIN( <br />GAS f (RED A C UNITS-TONNAGF EA <br />SHOWER <br />FORCED AIR $V STEMS -BTU AT EA <br />- <br />KITCHEN SINK A DISP <br />N'ALLHIA1fR5-BTU M <br />DISWASHER <br />UNITHMIFRS-BTU M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASI/I R <br />CLOTHES DRYERS <br />WATER HEATIH <br />V[NTIIATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLINGING UNIT- C F M <br />HANDLING <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE S CHIMNEY <br />ROOF DRAINS-RAINLEADLRS <br />SINK ISERVICL-BAR. FTC 1 <br />I <br />ctl <br />-- <br />SUB TOTAL S <br />- <br />SUBTOTAL <br />PLRMIT S <br />PERMIT S <br />TOTAL FIT S <br />TOTAL III S <br />SIDE YARD $ETBACK SiRI IT SITIIAIKMVAAN <br />D 51 -0ACK <br />PI AN CHICK NUMIII 11 PLAN CHECK FEE <br />RECEIPT NO <br />Fit <br />USEZONE <br />LOT AREA <br />SITE <br />FEES <br />VALUATION <br />FEE <br />DYESNO <br />TYPE OF CONSI <br />OCCUPANCY GROUWELLING <br />UNITS <br />BUILDING <br />S� <br />ai <br />SIZE OF BLOC <br />NO. OF STORIES <br />TOADPLUMBING <br />FIRE ZONE <br />BASEMENT <br />BIDREQINKLERS <br />MECHANICAL <br />INOAPPROVALS <br />DATE <br />OTHER <br />I ENVIRONMLNTAL CHECK LISTPI <br />N'ALiY <br />U.BC. <br />SIC 1071i1 <br />2 BUILDING PLAN$ <br />TOTAL <br />FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERM( PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />WHEN VALIDATION <br />5 GRADING XCAVATION A CLIARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B lit ALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9179 <br />