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APOLICATION FOR * <br />oft F "" <br />CITY OCONSTRUCTION Pi <br />CITY P <br />ever•ett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />�.. ZIP PHONE <br />PI l'MP6f. NNLRACIOR MAIL ADDRESS <br />CITY 21P PHONE LICENSE <br />1❑NE1W'ORK❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE []SIGN ❑GARAGE ❑BUILDING RELOCATION <br />,MU I0 01 WORK <br />IIHCRIHI PORK A r %/Z <br />PROPOSE D LSI Of BUILDING <br />LELU DISCRIPTION V1'R,,e,u„v ­............ ....._...-- <br />,of -BLOCK OE <br />ION \DDXI,\ <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PLUMBING <br />TYPE OF FIXTURE <br />FEE <br />MECHANICAL <br />NO. <br />T E OF EQUIPMENT <br />AIR COND U ITS-1/N U <br />NO. <br />WAIFR CLOSET ITOIIE 71 <br />REFRIGERATION UNI15—M P [A <br />BATHTUB <br />1101L1R:—HP FA <br />LAVATORY IWA5119A51N) <br />__ _ <br />GAS FIRED AC UNITS —TONNAGE EA <br />SHOWER <br />fONC[D AIR 5\57[MS—BTU M <br />_ <br />KITCHEN SINK A LISP <br />WALL HE ATER$—B i U M <br />DISWASHER <br />UNIT 11UTERS—BTU M <br />LAUNDRY IRAY <br />EVAPORATIVE COOLERS <br />CLOTHE5 WASHER <br />CLOTHES DRYERS <br />WATER HEAIEN <br />VE NLIL ATION FAN <br />URINAL <br />HANG) HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— C F M <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />ME TAT f IRI PUCE & CHIMNEY <br />PZOOF DRAINS—RAINLEADERS <br />SINK (SERVICE —RAR. ETC 1 <br />SUB TOTAL <br />PERMIT <br />3 <br />SUN TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL iEF <br />S <br />PLAN CHECK <br />PUN <br />FEE <br />YARD SF iBACK <br />w !i1 <br />SiRFfi S[i .SCK NUR <br />n• <br />I'ARD510ACK <br />%INLR � FIRECEIPT <br />L <br />NO. <br />USE ZONE' lCT A4A <br />VACANT <br />FEES <br />VALUATION FEE <br />OYES5.IaSlil <br />TYPE OF CONS) OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG NO OF STORIES <br />MA% OCC LOAD <br />PLUMBING <br />FIRE ZONE BASEMENT I1f UROOVS <br />FIRESKLERS <br />RED <br />MECHANICAL <br />"�— ----- <br />Tr <br />,IVES ENO <br />APPROVALS <br />BY DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PFNALTY <br />UBC <br />SFC TOW <br />2 BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED <br />(IN THIS SPACE) THIS 15 YOUR PERMIT <br />5 GRADINCA M AVATION A CIA ARI NOIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR TCR ISSU ANCk BY <br />�n <br />