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the Eveigreen ALtILICATION FOR* <br />CITY OF NSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL I59-B745 <br />EVERETT. WA98201 ❑CO. IBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING <br />OWNFR ,P,_- L /Z�.e MAIL ADDRESS CITY ZIP <br />OR <br />MAIL ADDRESS <br />d..�3dXSOf�1� 1 V yy2d':� <br />CITY <br />PERMIT NO. <br />Fei <br />CENTRAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE P <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE IICENS[ R <br />PIUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PITON[ LIC[NS[ S <br />CLASS OF WORK ��,,// <br />❑NEW ❑ADDITION EfALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Or WORK O <br />' , /'oo <br />DISCRIBT WORK <br />an f r�o-/ A a .spa"/-ro/ <br />PROPOSED us( oLATunowG <br />rr_ ;/.R,-1 "�/ <br />I HEREBY CERTIFY` HAT AVE 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 / e21�IQ <br />1 A [S i�IPI CYROP[ LEE (SHOWN HI LOW OR ATTACH FOUR COPUSI <br />WST 0 y`� 6Ft �1 J $ <br />LOT =BLOCK _Or <br />IOn ADDRI SS <br />2-ol-7 16X17-1Ce,.i' <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET DOLIET) <br />AIR COND UNITS-H P. EA <br />BATHTUB <br />REFRIGERATION UNITS -TIP tA <br />LAVATORY (WASH BASIN) <br />11011E RS-H P EA <br />SLOWER <br />GAS IIRLD AC UNITS -TONNAGE IA <br />K17CIIEN SINK R DISP <br />IORCFD AIR SYSTEM$-11 T U. MIA <br />OIS%VASHLR <br />\%AIL HEATERS- 1ITU M <br />LAUNDRY TRAY <br />UNIT IILATLRS-B T.0 AT <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WAIIIt HEATER <br />CIOT111S DRYERS <br />URINAL <br />\'I N'1 It AT ION FAN <br />DRINKING IOUNTAIN <br />RANGE HOOD <br />I IOOR DRAIN <br />AIR FAN 011 NG UNIT- C I M <br />VACUUM BREAK[. RS <br />STOVE <br />ROOF DRAIN$-RAINLI ADI ITS <br />N11 TAT. FIRE. PLACER CHIMNEY <br />SINK (SERVICE -LIAR, L IC 1 <br />SUBTOTAL <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 />RI AT YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />III <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />USES ONO <br />FEES <br />VALUATION <br />FEE <br />I YPE OF CLNST <br />-A) <br />OCCUPANCY GROUP <br />_ I <br />NO OF DWELLING UNITS <br />BUILDING <br />5 O" <br />- <br />SIZE OF BL DG <br />NO OF STORIES <br />AIAX OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />III URUrtSn <br />IHE SPRINKLERS <br />RIQUIRED <br />lIS (ENO <br />MLCHANICAt <br />APZROVAIS <br />BY <br />DATE <br />OTHER <br />1 LNVIRONMINIALCHHK LIST <br />PINA17Y <br />unc <br />SICSLC 3031a) <br />7 BUILDING PLANS <br />TOTAL <br />f� <br />3 IIRI HYDRANT <br />A FIRE PROTIC71ON SYSTEM <br />PERMIT VALIDATION <br />WHIN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIt XCAVATION A CLI ARINGIGRUBOING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STAFF Mt N1 <br />8. Ill ALIH DISTRICT <br />APPLICATION ACC BY <br />PI ANS CI ICKI 1) LN <br />V,cri <br />APPR I ON IS SI'AN(I IN <br />9179 <br />