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1 <br />the Evergreen ; O N ST R U C T I O P' <br />CITY DI <br />everett PERMIT PERMIT NO. <br />CITY HALL 259 87E5 <br />EVERETT, WA 98201 ❑ COMBINATION ❑ BUILDING gX MECHANICAL PLUMBING <br />OWNER MAIL ADDRESS PHONE <br />RIBYX Ness & Graham and Far West Equities <br />ARCHITECT OR DESIGNER MMI ADORE..g CITY 21P PHONE <br />PITY <br />21P <br />PHONE <br />LICENSEE <br />GENERAL CONTRACTOP <br />MAIL ADDRESS <br />ZIP <br />PHONE <br />LICENSE E <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />Same CITY ZIP PHONE LICENSE E <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CLASS OF WORK <br />❑ NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑ SIGN ❑ WOOD STOVEIFIREPLACE INSERT <br />VALUATION OF WORK <br />E <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />LEGAL DESCRIPTION OF PPOPERIY(SHOW BELOW OR ATTACH FOUR COPIES) <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />LOT_BLOCK_OF <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CO STRUCTION. <br />91ONAT THOR12ED AGENT DATE <br />JOB ADDRESS <br />+� 10/ <br />2501 Slst Place S.E. <br />X <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO.r <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSE- (TOILET) <br />AIR COND. UNITS - H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY(WASH BASIN) <br />BOILERS - M.P. EA <br />SHOWER <br />OAS FIRFO A UNITS -TONNAGE EA. <br />KITCHEN SINK B DISK <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <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 - WOOD <br />ROOF DRAINS - RAINLEADERS <br />1 <br />METAL FIREPLACE 1 CHIMNEY <br />SINK (SERVICE - BAR. ETC) <br />FIREPLACE INSERT <br />HEAT PUMP <br />SUB TOTAL <br />1 <br />SUB TOTAL 1 <br />PERMIT <br />1 <br />PERMIT 1 <br />TOTAL FEE <br />1 <br />TOTAL FEE 1 <br />7 <br />50 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />- <br />YES NO <br />- <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />1 <br />S12E OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />_ <br />FIRE ZONE BASEMENT <br />REQUIRED KLERS <br />MECHANICAL <br />7 <br />SO_ <br />YES NO <br />APPROVALS <br />BY DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303 (A) <br />2. BUILDING PLANS <br />TOTAL <br />7 <br />50 <br />3. FIRE HYDRANT <br />E. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PRI)"R,T VALIDATED (IN THIS THISJSOY(�U7PER�IIT <br />S. GRAOIN6 <br />SPACE) <br />•4 <br />Add t0 Permit #12331 O C+ U L� u LL, <br />n,1 <br />YOUR RECEIPT I <br />B. DRAINAGE <br />?.ENVIRONMENTAL IMPACT STATEMENT8. <br />HEALTH <br />APPLICATION CCTBY <br />PLANS CHECKED BY <br />APRIL FOR ISSUANCE BY <br />i11,1NK YOU <br />ADDRESS FILE <br />1 2 OCT 8 3 <br />