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the Evergreen APPLICATION F O R <br />CITY OF CONSTRUCTION '" <br />everett PERMIT Ei <br />DTPT OF COMMUNITY DEVELOPMENT SCRVICES , <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING []MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER �1I MAIL ADDRESS CITY ZIP - PHONE/ <br />r7I -C�/E--1'���� 341/7 /iIA�T/1n�,AhA F�i LP.`iJ /ZL. �Z2-10 ..0 sJ _ uJ/ �✓ <br />� —� .on ulyONIR MAIL ADORE 55 CiIY ZIP ' PHOMI <br />P,VMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION KRLPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VAEUAI ION Of WORK <br />5 /. A _ - _ <br />I <br />PROMS[ 00 f OF XU II D&C <br />I I C Al DI SCRIPTION OF PROPERTY (SHOWN R[LOW OR ATTACH FOUR COPH 5) <br />LOT -!7— RIOCK OF <br />�o7' 9 P•fa/ <br />TOR ADDRESS <br />PLUMBING <br />NO. TYPE OF FIXTURE FEE <br />AATIR CLOSET COLIETI <br />IIAlHTUB <br />1 AVATORY f WASH MAIM <br />SHOWER <br />KITCHEN SINK IS, DISP <br />DISWASHER <br />LAUNDRY TRAY <br />CLOTHE5 WASHER <br />WATER HE ATER <br />URINAL -- <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />STREET SETBACK <br />LOT AREA <br />OF COAST I OCCUPANCY GROUP <br />FIRE ZQNE <br />APPROVALS <br />1 ENVIRONMENTAL CHECK LIST <br />2 BUILDING PLANS <br />3 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />VACANT SITE <br />,!YES ❑NO <br />10 OF DWELLING 1 <br />MAX OCC LOAD <br />FIRE SPRINKLERS <br />REQUIRED <br />iYFt ❑NO <br />FLY DATE <br />I HEREBY CERTIFY THAT 1 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 />-r ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />x <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />AIRCOND UNITS -HP IA <br />Rf Fl%IGERATION UNITS-H P LA -- <br />OOd[RS-HP [A <br />GAS FIRED AC UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS-B T U M EA <br />WALL HEAILRS-BTU M <br />UNIT HEATERS-87U M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION fAN <br />RANGE HOOD <br />AI0. HANDLING UNIT- C F M <br />S-.OVE <br />Mf1AL FIREPLACE A CHIMNEY <br />5 GRADINGIIXCAVATIONACLLARINGIGRUBHING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />R HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY APPR IOR ISSUANCE BY <br />PERMIT S <br />107AL FEE ! <br />PLAN CHECK Fit <br />EEL RECEIPT NO. <br />VALUATION I FEE <br />BUILD'NGE�- <br />PLUMBING <br />MECHANICAL <br />OTHER _--- — <br />Pf NA'TY UHC. _— <br />SEE. 303W <br />TOTAL <br />PERMIT VALIDATION ..� <br />W HL N PROPE RLY VALIDATED TIN 1 HIS SPACEI THIS IS YOUR PERMIT <br />'q• 9.1 79 <br />