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APPLICATION FOP !e' <br />the Evergreen <br />CITY ve CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9c201 COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT <br />OWNIR _ <br />MUI AOOMI55 CIIY 21> PHOH[ <br />MAILADDRISS CITY °^ <br />MICHANICM CONTRACTOR MAIL ADDRESS <br />CITY LIP PNONF (ICI N$! <br />PIVMRINC CONTRACTOR MAILADDRISS <br />CIIY 21P PHOW lIClHSF E <br />CLASS Of WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR []DEMOLITION❑FENCE�I RJCN ❑GARAGE BUILDING RELOCATION <br />DLSCRIRI WORK <br />Pill <br />LEGAL DISCRI PTION OT PROPIRTY (SHOWN BLIOW OR ATTACH FOUR COPIIS) <br />LOTS BLOCK �OF <br />IOR AOORI55 <br />►LUMRING <br />NO. I TYPE <br />VAR( <br />ZONE (LOT ARIA <br />AMROVALS <br />1 ENVIRONMENTAL CCECR LIST <br />2 BUILDING PLANS <br />l FIRE HYDRANT <br />R (IRE PROTECTION 5Y511M <br />5 GRADINGIIXCAVATIONACEEAKINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />R HEALTH DISTRICT <br />APPIICATION ACC BY I PLANS r,1fe1CKEj <br />6 <br />f Ef <br />VACANT SIZE <br />AYES DNO <br />RY <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 COHTMCTOR OR AUTHORIZED AGENT DATE <br />-HP EA <br />D A C UNITS-TONNAI <br />AIR SYSTEMS-B T U <br />AIERS-B T U M <br />ATLRS-BTU M <br />ATIVE COOLERS <br />DRYERS <br />TION FAN <br />FOOD <br />OF INC UNIT— CI <br />FEE <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />DATE I OTHIR <br />UBC <br />PENALLY SEC 1034R) <br />FEE <br />RECEIPT NO. <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN T IS SPACE) THIS IS YOUR PERMIT <br />�wak.-- <br />jy_APPR FOR ISSUANCE BY <br />9-1 79 <br />