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the Evergreen APPLICATION FOR, �Y�ERH <br />CITY OF � ONSTRUCTION <br />everett PERMIT e <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWINIRS {� ) MAIL nppxr55 /• CITY ZIP PHONE <br />LLL,.! <br />IA' 32/7 aye <br />MAIL ADDRESS <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE E <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE IF <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSEE <br />CLASS OF WORK r�� •� <br />❑t:EW ❑ADDITION ❑ALTERATION L?REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />Y'ALUATION Or WORK <br />S A C-.3e- <br />DESCRIBE WORK <br />�.- <br />PROPOSED USE OF npING F <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 />'7 <br />U UL DI SCR( NOF PROPERTY (SHOWN 0 OR AITA'H f UR COPY SI <br />Lo%3=� eLOCr.or <br />ION ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIETI <br />AIR COND U ;,ITS—H P EA <br />RAIHTUB <br />REFRICERATION (.NITS—H P FA <br />LAY ATORV(WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRYTRAY <br />UNIT HEATERS —BTU M <br />CIOIHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOL VTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAIINLIAMAS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />SUB TOTAL <br />SUB TOTAL { <br />PERMIT <br />{ <br />_ <br />PERMIT { <br />TOTALFEF <br />{ <br />TOTALFFE <br />{ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHICK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT S1TE <br />OYES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />NO OF DWELLING UNITS <br />BUII DINE <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />fill( ZONE <br />BASEMENT <br />III ONOOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />'IYFS CNO <br />ASE CHANICAL <br />A►►ROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PI NAl1Y <br />UBC <br />SIC SEC 103(a1 <br />Z BUILDING PI ANS <br />1 FIRE HYDRANT <br />TOTAL <br />A TIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN TROPE RLI VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />S GRADING4 X(AVAIION A CL 1 ARINGIGRUBRING <br />N DRAINAGE <br />7 ENVIRONMENTAL IMPACT Si MEMENT <br />R HEALTH DISTRICT <br />APPLICATION ACC M PLANS CHECKED BY <br />APPR [OR ISSUANCE BY <br />