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the Evergreen <br />CITY OF <br />APPLICATION FOR <br />LJNSTRUC TION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 ❑COMBINATION <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />It <br />GENERAL CONIRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 1 <br />to <br />NIICHSNICAI CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE / <br />TFiR -4,4QU �Ck Tet.1iU` <br />PLUMBINC CONTRACTOR MAR ADOR S CITY ZIP PHONE LICENSE 1 <br />5E�. _ <br />CLASS OF WORK <br />❑NEW [:]ADDITION ❑ALTERATIONREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALU ,TION OF WORK <br />DESCRIBE WORK .�� �� <br />CLW 1= ""% U%Ac'-m lLill. ��YAja <br />PROPOSED USE OT BOLDING <br />mm - dj <br />LEGAL MSCRIPIION OF PROPERTY (SHOWN BELOW OR ATTACHE UR COPIES) <br />LOT OW BLOCK: OF <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 />AN THER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />O RFORMANCE OF CONSTRUCTION. (•�ry' <br />S TUBE F C FIECTOR OR AUTHORIZED AGENT DATE <br />X SS <br />MECH LAICAL <br />A DL <br />IOVNgADDRE 55 <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIET) <br />AIR CONE)UNITS-H P. EA <br />BATHTUB <br />REFRIGERATION UNITS -HP EA <br />LAVATORY (WASH BASIN) <br />FOIL[ RS-H P EA <br />SHOWtR <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK & DISP <br />..i� <br />fORCFD AIR SYSTEMS -BTU 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 FANEtc <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF GRAM- -RAINLEADERS <br />NIETAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR. ETC 1 <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />b <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <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 />L(/ <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />LIE DROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />CTYFS ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U BC <br />SEC. 30J(a) <br />Z BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION / <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT T�K/ <br />5 GRADINGA KC AVAT ION& CLEAR I NCIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPLE FOR ISSUANCE BY <br />9.1-79 <br />