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the Evergreen APPLICATION F O R <br />CITY OF Ii,..ONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA9B20T ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑P <br />PERMIT NO. <br />PLUNGING CONTRACTOR MAIL ADUPEIL CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />❑NEW ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑ BUILDING RELOCATION <br />VALUATIONOF WORK <br />, Fn <br />PROPOSED USE OF BUILD) <br />C' • <br />r " <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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR TA A OF CONSTRUCTION. <br />E N OR AUTHORIZED AGENT DATE <br />CR1SILNA ON <br />X <br />IEGM OE P110N OF PROPERTYI WN allow OR iTACM FOURC Hsl <br />LOT` �10 BLOCK 14 OF <br />r f <br />JOB ADDRI S% <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />SA'ATFF CLOSET ITOI. IFTI <br />AIR COND UNITS -HP FA <br />BATHTUB <br />REFRIGERATION UNITS -IS P EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H P EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK b DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL HEATERS-B.T U. M <br />LAUNDRY TRAY <br />UNIT HEAEERS-B.T U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RMNLLADE RS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE - BAR. FTC ) <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT IF <br />TOTAL FEE <br />S <br />TOTAL FEE IF <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBED <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />[]YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />SIZE OF BIDG <br />NO. OF STORIES <br />MAX OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BLOROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC. <br />SEC. 305(a) <br />2 BUILDING PLANS <br />TOTAL <br />7g <br />C <br />7 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHIN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION B CIE ARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />R HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />