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the Evergreen APPLICATION F O R <br /> OF o <br /> clrY evrreH <br /> CITYt CONSTRUCTIONeveret <br /> e <br /> DEPT OF COMMUNITY DEVELOPMENT SERVICES PERMIT <br /> CITY HALL 2S9.8745 <br /> EVERETT.WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br /> DWNIN MAII ADDRESS III PHONE <br /> � o = � �� Pl. st.J E� e.vlz� gSzo <br /> A.111.111:1 OR UI SIC IR MAIL ADDNI SS [TTY IIP PHON! <br /> Of NIRAL CONTRA(TOR MAR ADDRISS CITY ZIP PHONE LICENSE <br /> MICHANICAL(ONIRACIOR MAIL ADDRISS CITY ZIP PHONE LICENSII <br /> PLUMBINGCONINACtOt MMI ADONIS$ CITY ZIP PHONE IICINSII <br /> CLA%SOF WORK <br /> ❑NEW ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUIIDINGRfLOCATION <br /> vewAno�r WORK <br /> DESCRIBE WORK // <br /> N('y 11 V I—c re a`1'1'r„ 'Ctlt� <br /> PRoroslUus!DI RUILOINc I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> I ICA(DISOLIPUON Or PROPIRIYISHOWN RILOW OR ATTACH FOUR COPHSI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> Lot LBIOCK_OI a e,tKi+ I A 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 /> SIGNATURE Of CONTRACTOR OR AUTHORIZED AGENT DATE <br /> TOB AUDRI55,� <br /> 2771 <br /> PLUMBING MECHANICAL <br /> NO TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> W'AIIR Ct0SFTITOLIFI) AIR COND UNITS—HP [A <br /> BATHTUB RIFRIGFRA71ON UNITS—H P FA <br /> LAVATORY IWA5H BASIN/ I BOILERS—HP IA <br /> SHOWIR GAS EIRFD AC UNITS—TONNAGE LA <br /> KITCHEN SINK 6 DISP IONCE 0 AIR SYSTEMS—B T U MFA <br /> DISWASHER WALL HE ATERS—BTU M <br /> IAUNDRYIRAY UNIT HIATIRS—BTU M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> _ WATER H[AIfR CLOTHIS DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C r M <br /> VACUUM BREAKERS 510111 <br /> ROOF DRAINS—RAINL E ADERS Mt1At FIREPLACE A CHIMNEY <br /> SINK ISIRVICI—BAR,FTC 1 <br /> SUB TOTAL SUR TOTAL s <br /> PERMIT s PERMIT s - <br /> TOTAL FIE f TOTAL Fit I C <br /> SIDE YARD SETBACK STREET SETBACK REAR YARD SI TRACK PLANCHIC NUMBER p PLAN CHI CK III <br /> �D93S FfF�(�3 <br /> RECEIPT`EIN� J <br /> USE ZONE LOT AREA yACANTSII <br /> 07 DYfS CFO fill VALUATION Ft[ <br /> TYPE Of CONST OCCUPANCY GROUP NO OF DWELLING UNITS <br /> sr- TJ AmAJ R3 I <br /> SIZE OF BLDG NO OF STORIES MAX IXC IOAD BUILDING f <br /> ADDIU j56 !' 1 1 — PLUMBING <br /> FIRE ZONE BASEMENT III DROOMS FIRE SPRINKLIRS <br /> -- n VIMECIIANICAL <br /> APPROVALS BY inn DATE OTHER <br /> I FNVIRONMINIAL CHECKLIST <br /> PINALTY U.BC <br /> 7 BUILDING PLANS SEC 10x1) <br /> 1 EIRE HYDRANT TOTAL <br /> A FIRE PROTECTION SYSTEM PIRMIT VALIDATION <br /> S GRADING/[XCAVATION A CIEARINCICRUBRING WHEN PROPERLY VALIDATED TIN THIS SPACE)THIS IS YOUR PERMIT <br /> L6 DRAINAGE <br /> 7 ENVIRONMENTAL IMPACT S1ATfMLNT <br /> B HEALTH DISTRICT <br /> APPLICATION ACCBY PIA NS CHECKED BI AI'I`R 1(IN I%%UANCI BY <br /> 1l✓1 c - <br /> 9.1-79 <br /> -91 79 <br />