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the Evergreen <br />CITY OF <br />APPLICATION FOR <br />CONSTRUCTIG. J <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT,%V'A 98201 ❑COMBINATION <br />MAIL ADDRESS <br />BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />C!-I <br />201 ZS$ e2(. <br />PHONE <br />everett <br />e <br />CENTRAL CONTRACTOR MAIL ADDRESS On ZIP PHONE LICENSE R <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE R <br />PLUMRING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE R — <br />CLASS OI N'ORK rr..�� <br />❑NEW ❑ADDITION E!ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUA71ONNOf 11OR1. <br />li awn <br />DISCRIHI NUR, <br />7�=N IIr-7 11 APQr3"J WM6 v'TS <br />rROPCYED L S 1 04 HU I L DI NI: <br />UAA) cM--i(L <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 I HIS 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 />SIGNAIURf OF CONTRACTOR OR UTHORIZED AGENT DATE <br />x Iizq16Z <br />LEGAL TIT SCRIPI ON OF PROPI RI. o iol -, nl tOA OR AI1Pu1 FOUR COPIE51 <br />LOTBLOCK —OF <br />Inn Auoal ss <br />O0I l ST (3lOG ITT <br />PLUMBING <br />IMECH <br />NICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />TYPE OF EQUIPMENT <br />FEE <br />SYAT LK CLOSE I(IOL IF I I <br />AIR COND UNITS -HP LA <br />BATHTUB <br />REFRIGERATION UNITS -HP [A <br />LAVATORY (WASH BASIN) <br />BOILIRS-HP [A <br />SHOWER <br />GAS FIR I AC UNI75-TONNAGE I <br />KITCHEN SINK A DISP <br />FORCED AIR SSST[MS-BTU MIA <br />DISWASHFR <br />WALL HEATERS -BTU M <br />LAUNDRYIRAY <br />UNIT HATERS -BTU M <br />C LOIH[S WASHER <br />(VAPORATIVF COOLERS <br />"ATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VL NIILATION FAN <br />DRINKING FOUNIAIN <br />RANGE HOOD <br />I LOOR DRAIN <br />AIR HANDLING UNIT- C F AI <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLEADERS <br />NiFTAl FIREPLACE A CHIMNEY <br />SINK ISFRVICI —BAR, EIC ) <br />Site TOTAL <br />SUR TOTAL S <br />PERMIT <br />3 <br />PERMIT f <br />TOTAL FEE <br />S <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />SIRE[T SETBACK <br />BEAR YARD SETBACK <br />PLAN CILECK NUMBER <br />p <br />I <br />PLAN <br />Ft i� <br />;2 <br />CHECK FEE <br />REC[IP7 NO. <br />0 TIT <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES CNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />NO OF DWI LLING UNITS <br />BUILDING <br />S <br />SIZE OF BLOC <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BE DROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />15'IS FIND <br />MECHANICAL <br />_ <br />APPROVALS <br />BY <br />LATE <br />OTHER <br />1 ENVIRONM[NTALCHICKILST <br />PENALTY <br />URC <br />SIC. .103Ia) <br />2 BUILDING PLANS <br />TOTAL <br />1 FIR[ HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRADINGILXCAVAIION A CLEARING!GRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />eee <br />0 <br />6 DRAINAGE <br />7. [NVIRONMENIAL IMPACT STATEMENT <br />A HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PCANS CHECKED BY <br />AVPR FOR ISSUANCE BY <br />91-79 <br />