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rAPPLICATION FOK 16- <br />Ms EwrproBnCITY OF CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />I CITY HALL 259-8745 <br />i EVERETT, WA 9B201 OCOMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNIR NAIL ADORI}S CITY ZIP PHONI <br />.a_n A . D A <br />MAIL <br />CENTR///AL... C�O'`NTRA(' TOR <br />MAIL ADDRESS <br />CrtY <br />�elo'IfGe <br />ZIP <br />9gl33>% <br />PHONE �LICENSC4 <br />9T�CO <br />I I9oAT <br />MIC1lAM1ICALC!S <br />MAIL RS-tou2,4UEuo <br />ESSCI <br />IY <br />ZIP <br />PHONE LICENSE I <br />PIDMBIN; CONTRACTOR MAIL ADDRESS Lily ZIP PHONE LICENSE <br />Cl US III V:URF <br />52<EW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />Y AIVATION OF WORK ov <br />Zaoo <br />Ill }GAIN) WORK <br />.I <br />.-tf4 11 O N -:) "' u I ulLx,w , - <br />rRoroslDLM of Ru II DING <br />- - <br />1 HEREBY CERTI Y 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 KITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOL!'TE 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 />X S S FC`-' ' GFi. S 3 O p <br />IICAL Of SCRIPTION OF PROPE RTY ISH011, BE OR ATUCH FOUR COPIES) <br />LOL _BIOCK_Of <br />II IO111PRI VI S� oQ1 E+l.) wit. <br />PLUMBING <br />.MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATIR CLOSET (TOLIET) <br />AIR CONTE UNITS—H P [A <br />BATHTUB <br />REFRIGERATION UNITS —HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS—B T U MCA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRY IRA) <br />UNIT HEATERS—BI U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING I0 UNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLE ADE RS <br />MITAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ITC) <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT t <br />PERMIT t <br />TOTAL FEE t <br />TOTAL FEE If <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 />OYES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF COAST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S ZDDo, L'� <br />C <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASF MEAT <br />IIl DROOMS <br />FIRE SPRINKLERSECHANICAL <br />REQUIRED <br />— <br />OTHER <br />APPROVALS <br />1 ENVIRONMENTAL CHECK LISTENALTY <br />U.BC. <br />SEC 303(a) <br />2 BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />�— �( p7 <br />f /��8� GAPPLICATION <br />S GRADING4 XC AVA I ION A CLURINCIGRUBRING/ <br />6 DRAINAGE <br />ENVIRONMENTAL IMPACT STATEMENTB <br />HEALTH DISTRICT <br />ACC BY <br />PLANS CHECKED BY <br />9.1-79 <br />B <br />