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the Evergreen APPLICATION FOR <br />DITYDP .,ONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 []COMBINATION ❑ BUILDING ❑MECHANICAL <br />O�WN[1R / /� 1 M(AIIADDXF55 ❑TY <br />`'7K", CJ I-(, I I <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY <br />MAIL ADDRESS <br />MAIL <br />CITY <br />❑PLUMBING PERMIT NO. <br />ZIP PHONE p44 - S <br />everett <br />lI <br />. C7 / S <br />LICENSE R <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />CLASS Of WORK <br />❑NEW RADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />-3 27, 5-00 <br />DISCRIBE WORK / q <br />'t[7-4ilLEyc� <br />PROPOSED USE OF BUILDING _ <br />S <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 L BE FIED HEREIN <br />OR NOT THE GRANTING LOFF A PERMIT DOES NOT IED WITH WHETHER IPRESSUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR T EIRE OF{ORMA TOR OF CONSTRUCTION. / <br />SIGMA URE OF CJt1NiRACTOR OR AUTHORIZED AGENT DATE <br />X � <br />LEGAL DESCIPTION OF PROPERTY PSHCPYVVN BELOnW OR ATACH {OUR COPIfSI <br />-I �I) etocKor <Ai'YIM r� <br />LOT f <br />33rd <br />JOB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIETI <br />Lam` <br />AIR COND UNITS—H P EA <br />BATHTUB <br />REFRIGERATION LIMITS—H P EA <br />LAVATORY (WASH BASIN) <br />Cii <br />BOILERS—H P EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-H F U M EA <br />DISWASHER <br />WALL HEATERS-B T U M <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU 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 />>7__ <br />_ <br />ROOF DRAINS -RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK (SERVICE -BAR. ETC I <br />SUB TOTAL <br />L <br />GL.' <br />SUB TOTAL <br />PERMIT <br />$ <br />-'-" <br />PERMIT 3 <br />TOTAL FEE <br />f <br />I.- <br />7L- <br />TOTAL FEE 3 <br />_ l� <br />•jZ� <br />SIDE YARD SETBACK <br />br--( <br />STRf ET SETBACK <br />ZEE'-r <br />REAR YARD SETBACK <br />7�ET C---T <br />PLAN CHECK NUMBER <br />y� <br />JCVACANT <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPTUSfZONE <br />LOT AREA <br />SITE <br />❑YES QCNDTYPE <br />FEE <br />VALUATI <br />F1J._I <br />I <br />OF 51 <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITSIIBUILDING <br />S 2Sz <br />I C'4 <br />o C <br />SIZE OF BLDG <br />NO OF STORIES <br />2 <br />MAX. OCC LOAD <br />— <br />PLUMBING <br />FIRE ZONE <br />__• <br />BASEMENT <br />N�J <br />"1 <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRF,D <br />OYES QENO <br />MECHANICAL <br />4 <br />c <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />LIRE <br />SIC ]BJ(a) <br />2 BUILDING PUNS <br />TOTAL <br />B FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 GRADINGIE XCAVATIONA CLFARINCIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />' `""F"S P/Jiloa� T2 �j`Q(�•�� <br />P�-•O ,. ,. pE ,a / <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DIS-RICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />V. <br />APPR FOR ISSUANCE BY <br />L c- <br />3 <br />91-79 <br />