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a <br />the Evergreen <br />CITY OF <br />APPLICATION FOP <br />CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT,WA98201 ❑COMBINATION PgUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />161 <br />OWNER <br />5`iC uJA t T' pA\J1D <br />MAIL ADDRESS <br />Soza-7-72� N" u? <br />CITY <br />C-yr-9t2E71 <br />ZIP <br />98zoa <br />PHONE <br />- qs- 3RC 2_ <br />ARCH) CTOR ❑ISIGNIH�� <br />r. s b u 77-s R F I E; Lb <br />MAIL ADDRESS <br />zqt s A *e w I -Tr- ALA <br />CITY <br />ZI <br />zo ) <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSEE <br />6EvNF R <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHON1 LICENSE I <br />PIUMRING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />CUSS Of WORK <br />❑NEW li�<IDDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUAUON OF WOR;ATS, <br />3 1 S"oa . <br />DISLIIIIII WORK QDD1TIarL1 VnfDE-k HOOS� CDtJE RAoM� r <br />PROPOSE USE of BUBDISC <br />'kp,'r D'F (400E-- — <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 CONTRACTOR OR AUTHORIZED AGENT DATE <br />Av L`L T LjC7L.Ja.+ <br />I EGA). DESCRIPTION Of PROPERTY (SHOWN BELOW OR ATTACH FOUR COPBS) <br />LOT 6FALOCK_or C- S <br />IOH ADDRESS 1 A fI�~.�CI l <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND UNITS—FIP EA <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />REFRIGERATION UNITS—H P. EA <br />BOILERS—H P EA <br />GAS FIRED AC. UNITS —TONNAGE EA <br />R. <br />KITCHEN SINK A, DISP <br />FORCED AIR SYSTEMS—B T U AT EA <br />DISWASHER <br />WALL HEATERS—BATTU <br />LAUNDRY TRAY <br />UNIT HEATERS—BT U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URI JAL <br />VENTILATION AN <br />ORINI.'NG FOUNTAIN <br />RANGE HOOD <br />FLOOR is A1N <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOT' DRAINS—RAINLEADF RS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (So RVICE—BAR, FTC) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE 3 <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD` SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FFE <br />/(.. 25 <br />CHECK FEE <br />RECEIP O <br />6-T�2'3 Co <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />EYES CNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />BUILDING <br />Si <br />�1 <br />Cy3^ <br />SIZE OF PLUG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />IIIDROONti <br />FIELf SPRINKLERS <br />REQUIRED <br />lYES ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBI . <br />SEC 3031a) <br />2 BUILDING PLANS <br />TOTAL <br />T FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADING4 XCAVAT ION R CLEARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE NY <br />9-1-79 <br />