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r <br />the Evergreen APPLICATION FOR everen <br />CITY OF �AONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />r CITY HALL 259 8745 <br />EVERETT. WA98201 ❑COMBINATION ❑ BUILDING ZMECHANICAL ❑PLUMBING PERMIT RO. <br />r <br />LAI <br />L <br />M V L ADDRESS <br />MECHANICAL CONTRACTOR <br />PHONE LICENSE r <br />PHONE A� • CU .�• LICENSE # <br />'h-4h,w A/Ili 4 <br />PHONE LICENSE# <br />CL SOF WORK ,,.�// <br />NEW ❑ADDITION IYJALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION` <br />VALUATION OF WORK <br />DES IBF WORK ��YY <br />FRoros UST f BUILDING <br />A <br />(71 <br />7 HIS AP- <br />1 EREBY CERTIFY THAT I HAVE READ AND EXAMIN <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 COMPLI!D 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 CONTR TOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DTSCRIPTION Of PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIESI <br />TOT —BLOCK ^OF <br />IUe ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATT R CLOSET I TOUR! <br />AIR COND UNITS—H I' IA <br />BATHTUB <br />REFRIGERATION UNITS —HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWfR <br />GAS FIRED AC UNITS-10NNACL EA <br />KITCHEN SINK A LISP <br />FORCI I) AIR SY SI L MS—B T ME" <br />❑15WASHER <br />WALL HE AIERS--ITIL M <br />LAUNDRY TRAY <br />UNIT HATERS —BTU M <br />CLOTHES WASHER <br />IVAPORATIVF COOLERS <br />WATER WATER <br />CLOIHf 5 DRYFRS <br />URINAL <br />VENIILATION IAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C I M <br />VACUUM BRLAKERS <br />STOVE <br />ROOF DRAINS—RAINLEAD FL$ <br />METAL IIRFPIACI A CHIMNEY <br />SINK ISf RV'IC—IIAR. I TC 1 <br />SUBTOTAL <br />SUBTOTAL f <br />6+ <br />PERMIT <br />S <br />PERMIT f <br />TOTALFEE <br />S <br />TOTAL FEE R <br />SIDE YARD SETBACK <br />STREET SETBACK <br />RE AR YARD SETBACK <br />PLAN CHECK NUMBIR <br />PLAN <br />fit <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYE5 ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />EIUILDING <br />S <br />SIZE OF BLOC. <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BE GROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />-]YES ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMLNTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC )OTIA) <br />: BUILDING PLANS <br />TOTAA <br />FIRE HYDRANT <br />< FIRE PROTECTION SYSTEM <br />5 GRADING. f XCAVATION TS CIA ARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATLD (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPLE FOR ISSUANCE BY <br />j <br />L <br />9-1-79 <br />d <br />