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APPLICATION FOR <br />CITY OPeel <br />the Evergreen CO TRUCTION <br />CITY PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT• WA 98201 ❑COMBINATION ❑ BUILDING El MECHANICAL ❑PLUMBING PERMYT <br />m10Ni <br />OWNER MAIL ADDRISS CI IN <br />RAE CONT%RR�AACTOR j <br />&Jl ,l /TN,a.e(1 lT /i <br />MAIL <br />CLASS Of WORK <br />❑N-W ❑ADDITION ❑ALI ERATION <br />VALUATION OI WORK <br />S2, <br />DESCRI E WORK <br />7,X' t e 1-I r ? LA / r- <br />rROFov/�??O uSi or nu)LDING <br />/tQS�r -(FE e d " <br />LEGAALR <br />L DESCRIPTION Of PROPERTY (SHOW'N RELAO'W UK AT TA[II FO <br />LOT Z T n BLOCK TC <br />-- 5' 44� l-I oh i a 6 v-i?/, <br />lk <br />❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUDDING RELOCATION <br />4 '% i k i , f"Was Lvt u ldrt <br />I HEREBY CERTIFY THAT I ItJ.VE 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 HEPEIN <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE <br />AUTHORITY <br />O <br />R CANCEL THE PROVISIONS OF <br />ATE OR LOCAL LAW REGULATING CONSTR <br />ANYOTH RSUUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Of CONE`CTOR OR AUTHORIZED AGENT DATE II r <br />Z_ . oi.�iF F ✓I� 1tl <br />ELT I <br />ME ANICAL <br />PLUMBING <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYP'_ OF FIXTURE <br />FEE <br />AIR COND UNI75-III' IA <br />WATER CI OSET (In' <br />RI FRIGERA710N UNIT$-11 P. f A <br />BATHTUB <br />I10TERS-H.P. CA <br />E AVAIORY (WASTE BASIN) <br />CAS FIRED A C UNITS -TONNAGE EA <br />SHOWER <br />IURCLD AIR SYSTEMS-B.T.G Al FA <br />KITCHEN SINK & DISK <br />'AALL HEATERS-11.T U Al <br />DISWASHTR <br />UNIT HEATERS-B I M <br />I AUNDRY TRAY <br />I VAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />\q NITRATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HAND(INC. UNIT- C I M <br />FLOOR DRAIN <br />57E1\'1 <br />VACUUM BREAKERS <br />MI TAI i1Rl PI ACI 6 CHIMNEY <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETCJ <br />SUB TOTAL $ <br />SUB TOTAL <br />PERMIT i <br />PERMIT <br />S <br />i01'AL FEE S <br />TOTAL FEE <br />S <br />PIAN CHECK NUMBER PLAN CHECK FEE <br />SIDE YARD SF 78ACR STRIFE SETBACK <br />NEAR YARD SETtlACK <br />HE RECEIPT NO. <br />USE ZONE TOT AREA <br />VACANT SITE <br />FEES VALUATION FEE <br />ONES ONO <br />OF CONST. OCCUPANCY GROUP <br />NO. Of DWELLING UNIT <br />TYPE <br />HOLDING <br />SIZE OF BLOG. NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE rA5[MCNT Ifl DROUSIS <br />RQU RED SPRINKLERSRE <br />MECHANICAL <br />OYES ONO <br />APPROVALS <br />BY DATE <br />OTHER <br />I1 IlC <br />1, E NVIRONMENTAL CHECK LIST <br />PENALTY SEC .OV11 <br />2. BUILDING PLANS <br />TOTAL <br />3. FIRE HYDRANT <br />PERMIT VALIDATION <br />TIN THIS SPACE) THIS IS YOUR PERMIT <br />q. FIRE PROTECTION SYSTEM <br />WHEN PROPERLY VALIDATED <br />5. GRADINGIEXCAVATION A CU ARINGfGRUBBING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC BY PLAN5 CHECKED [IN <br />API'R TOR ISSUANCE <br />UC/ <br />