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APPLICATION FOR OF eP <br />CITY OF PER, Evergreen L JNSTRUCTION <br />everett PERMIT <br />DEPT OF COALMUNITY DEVELOPMENT SERVICES ,_,., <br />CITY HALL 259-8745 ❑MECHANICAL Ll3T'LUMBING PERMIT NO. <br />EVERETT, WA 96201 COMBINATION ❑ BUILDING PHONE <br />ZIP <br />OW NFR All AODN155 <br />LI 1 �P T7n 1'20 � T, L'Uov� q��U <br />� � Tc.+ c1i 1 P PHONE <br />ARCH IT E C T OR DE 51 GNIR MAIL ADOR{SS <br />VALUATION ., -ORK <br />1 <br />DISCRIflE W0R � �0. 1 <br />PROPOSIDUSIPROPOSIDUSI OF BUILDING i/1 <br />IEGAI DI SCRIPiIOH OI AROPl RtY ISNOWN BILOW OR ATTACH FOUR COPE") <br />LOl _ BLOCK OF <br />JOB ADDRIS+ <br />PLUMBING <br />SHOWER <br />KITCHEN SINK A DISP <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 W17H WHETHER SPL -IFIED HEREIN <br />ONOT. <br />AUTHOR AUTHORITY TO GRANTING <br />VIOLATEOR CANCEL DOES <br />T <br />GIVE HE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CO STRUCTION. <br />SIGNATURE Of CACTOR OR 1ORIZFQ AC[tlT DATE E <br />FEE NO.� ' TYPE <br />REFRIGERATION UNITS -HP EA <br />BOILERS-H P. EA <br />GAS FIRED A C UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS-B I U M EA <br />WALL HEATERS-BIU M <br />UNIT HEATERS-B T U M <br />EVAPORATIVE COOLERS <br />CLOTHESDRYERS <br />VENTILATION CAN <br />RANGE HOOD <br />AIR HANDLING UNIT- C f M <br />STOVE <br />METAL FIREPLACE A CHIMNEY <br />SUBTOTAL <br />I EAR YARD SETBACK PLAN CHECK <br />VACANT SITE <br />OYES ONO <br />VO OF DWELLING UNITS <br />LOAD <br />E BASEMENT RIOT J515 <br />REQUIRED.---..- <br />-JYES rNO <br />APPROVALS <br />BY DATE <br />ONMENTAL CHECK 1151 <br />ING PLANS <br />HYDRANT <br />nArrny <br />PR0IECIION SYSTEM <br />INGR %CAVATIOEVBCLEARINGICRUBBING <br />NAGE <br />IRONMENTAL IMPACT STATEMENT <br />TH DISTRICT <br />� ��. nnN A[[ 0Y PLANS CHECKED BY <br />APPR FOR ISSUAI <br />BY <br />— PLAN CHECK FEE <br />FlE I RECEIPT NO. <br />BAIL DINT. <br />PLUMBING <br />MECHANICAL <br />OTHER <br />UTIC <br />PENALTY SEC 70Xa1 <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT <br />a-�/ ? ya <br />