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APLICATION FOR !Y!ElII <br />fM EY+FprRRn Om OF CONSTRUCTION Pi <br />everett PERMIT 4L` <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION CI BUILDING ❑MECHANICAL El PLUMBING PERMIT NO. <br />OWNER MAIL ADnRISS CITY 71P PHONE <br />rr-o, <br />!S/ Ste- v <n . E 'FZo' <br />OI SIGNfR 'r MAIL AAnDDDRI SS CITY `9210 PHONE <br />�/,F'LC(7ti- .) / � . �a,q / n /3mx L/c[. //i72na.,.� .•_ y �i'�7 5/L A/ s �s — ) � t — c/ci7/ <br />CITY ZIP PHONE LICENSE S <br />GI FFRAI CONTRACTOR MAIL Ap0R15S <br />PIOA,RINC CON iRACTOR MAIL AODRI55 <br />CITY ZIP PHONE LICENSE a <br />Cl US Of WORK <br />❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCESIGN ❑GARAGE ❑BUILDING RELOCATION <br />WNEW <br />\'MVVIO'-((IF WORK <br />!—�l <br />L Z om' 4.A/ <br />DISL RIBI WORK <br />AND EXAMINED THIS AP <br />rauvosfD o'I CIRURDING <br />1 HEREBY CERTIFY THAT I i:AVE READ <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />pa J r�on <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />IIUI DI SCRIPTION OF PROPERTY ISHOW'N BELOW OR ATTACH FOUR COPII SI <br />OF WORK <br />OR NOT THE GRANTING OF A PERMIT DOES NOT PRCSUME TO <br />101 _BLOCK_ Of <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />GIVE <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />OQ..j UTHORIZED AGENT DATE y:•/%P�n <br />SIGNATURE OF CO C10R <br />x %l <br />Sv n ioa <br />;A <br />MECHANICAL <br />PLUMBING <br />- <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE FEE <br />AIR UNIT$ -HP EA <br />W' A T l R C L 05 E T IT OF I FT) <br />REFRIGERA710N UNITS -HP [A <br />GER <br />BATHTUB <br />BOILERS -HP EA <br />I AVATORY (WASH BASIN) <br />GAS FIRED A C LINE i 5-TONNAGE EA <br />SHOYAI R <br />FORCE D AIR SYSTEMS- 0 T U M EA <br />KITCHEN SINK A DISP <br />S5'ALI MF AIER$-B 7 U M <br />DISWASHFN <br />UNIT lIl AIER$-BTU M <br />LAUN DRY THAN <br />EVAPORATIVE COOLERS <br />CLC ,HIS %RASHER <br />CLO7Hl5 DRY[RS <br />WMER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C F M <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />MI1AL IIRF PIAC[ 8 CHIMNEY <br />' <br />ROOF DRAINS-RAINL[ADLkS <br />SINK (SERVIC[ -BAR, ETC) <br />SUB TOTAL <br />S <br />SUBTOTAL <br />PFRMIT <br />S <br />- <br />PERMIT <br />S <br />TOTAL FEE S <br />TOTAL FKF <br />+HACK SIR[ ii Ef TRACK REAR <br />S <br />YARD SETBACK <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />SIDE YARDS[ <br />FEE RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SIZE <br />FEES <br />VALUATION <br />FEE <br />(7YES CNO <br />TYPE OF CO!-ST <br />OCCUPANCY GROUP NO <br />OF DWELLING UNITS <br />BUILDING <br />32 WElo <br />SIZE OF PLUG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE 79NE BASEMENT IIIUROUKri <br />FIRREQUIREDESPRINKLERS <br />MECHANICAL <br />F7YFS FTNO <br />APPROVALS <br />BY DATE <br />OTHER <br />PENALTY <br />UBC <br />SEC 307(a) <br />_ <br />1 ENVIRONMENTAL CHECK L15T <br />TOTAL <br />2 BUILDING PLANS <br />T FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WIZEN PROPERLY VALIDATED (IN THIS SPACQHIS FI$ YOUR PERMIT <br />5 GRADINGII XC AVATIONA CLI ARINGICRUNfl LNG <br />_ c/yam/Y <br />6 DRAINAGE <br />7 ENVIRONMF NTAL IMPACT STATEMENT <br />✓ <br />�//�/ /'��j <br />7 L .r7 // <br />as <br />l/ J lir "'�— <br />8 HEALTH DISTRICT <br />APPLIU710N ACC 8° �SfH CKED BY <br />�j <br />APPR FOR ISSUANCE flY <br />tellols Z) <br />91 79 <br />