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the Evergreen APPLICATION FOR <br />CITY 'OF CONSTRUCTION <br />everett PERMIT <br />everett <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 COMBINATION BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN•,R MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />� /.�fi�li'l�f� ���/✓�%.� �70 � �-2��� /����. � �. /� S %ctln.Ns E c.t �c/ �%�'.�S'� � �<i �r-"=3-c� <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />22 O / Fi-Tz-/ve 2zy <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE M <br />CLASS OF WORK <br />lEW []ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION El FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK o <br />DE SC 1Ef- ORK <br />/ r .fit <br />PROPOSED USE OF BUILDING <br />d e f --r I U S.1A o <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 />SIGNAT " E Of CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />E01 BLOCK OF <br />IOB ADDRESS <br />L/ <br />PLUMBING <br />E HANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOUET) <br />AIR COND, UNITS—H.P EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—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 />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL <br />SUB TOTAL $ <br />PERMIT <br />S <br />PERMIT 5 <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE 6 'Z�j RECEIPT <br />i2VV <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST, <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG, <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303(a) <br />2 BUILDING PLANS <br />3 FIRE HYDRANT <br />TOTAL <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGIEXCAVATION & CLEARINClGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC, BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />9.1-79 <br />