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irONSTRUCTION <br />PI (CATION FOB <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA98201 0 COMBINATION ❑ BUILDING <br />❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />OWNER N l 1SI1 ADDRts+ <br />t Iry <br />ZIP <br />PHONE <br />Acl�l <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />1�19c,9L9Y117 <br />CITY <br />r,A, <br />ZIP <br />PHONE <br />.56�-3r33 <br />_QOb <br />GENERAL CONTRACTOR ✓� MAIL ADDR6s <br />CITY <br />ZIP <br />PHONE LICENSER <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />( HY <br />ZIP <br />PHONE LICENSE X <br />PLUMBING CONTRACTOR 1 MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />1 I��`%e_ 1`�cr,el�e['�v tl,�ay l=L• �`i j-' 7Y73 _ <br />CLASS OF WORK <br />❑NEW ❑ADDITION ALTERATION ❑REPAIR ❑DEMOLITION ❑FEINC E ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />WA <br />VAWATIO' 1'WORK f _ <br />DESCRIBE wtAK A I F L( ) a )l Q ri!LL iJ f'�v 4 AIE n I .S7-nf/ 11rl-- Re-.-Yivt <br />PROPOSED USE OF BUILDING <br />SAi"?C. n S, U ,.P fic <br />Sv- <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 />/I 1_�. <br />X ��% . Gc .C'- �Z8 <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELC;W OR ATTACH FOUR COPIES) <br />LOT _BLOCK_ Of <br />IOR ADDRESS _ <br />%SC'( //f�& S'.L., <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIET) <br />AIR CONE. UNITS-H P LA <br />BATHTUB <br />REFRIGERATION DNITS-III' [A <br />LAVATORY OVASII 9ASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK & OISP <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISWASHCR <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHIR <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />6CJ <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLEADE RS <br />AIFTAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR, ETC <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />f <br />PERMIT S <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />SIDE YARD S TBACK <br />STREET SEIB CK <br />N�A <br />BEAR YARD $ TBACK <br />� <br />PLAN CH6CF: NUMBER <br />19. O-D <br />7JV E <br />PLAN <br />FEE <br />It <br />CHUCK I'LE <br />R117 NO. <br />. F <br />USFZ-O� <br />�f <br />F. --z- <br />LOT AREA <br />VACANT SITE <br />DYES XNO <br />FEES <br />VALUA710N <br />EE <br />II',PF OF COYST, - <br />I',F-�+'IpvEL N <br />OCCUPANCY GROUP <br />✓ Z <br />NO. OF DWELLING UNITS <br />BUILDING <br />fM Ol% <br />/)Q <br /><IZE OF BLDG. <br />._------ <br />NO. OF STORIES <br />---- <br />MAX OCC. LOAD <br />85 <br />PLUMBING <br />lfJ <br />FIRE ZONE <br />BASEMENT <br />-�' <br />IEDROOMIS <br />_ <br />FIRE SPRINKLERS <br />REQUIRE <br />❑YES '.<o <br />MECHANICAL <br />APPROVAIS <br />BY <br />DATE <br />OTHER <br />1, ENVIRONMENTAL CHECK LIST <br />UBCPFNAL7Y SEC J07(a) <br />2 flUILDING PLANS <br />TOTAL4. <br />B FIRE EDDRANT <br />FIRE PROTECTION SYSTEM <br />tm/'Aa <br />PERMIT VALIDATION <br />PROPERLY VALIDATLO (IN THIS SPACE(THIS IS YOUN PERMIT <br />i A P <br />A-GON��T 7-0 <br />/0, n'�'0 y% A45a�rq <br />5. GRADING fXCAVATION& CLEARING'CRUBBINC,WHEN <br />6. DRAINAGL <br />7. ENVIRONMfNTAI IMPACT STATEMENT <br />AY A-' <br />8. HEALTH DISTRICT <br />APPLICATION .ACC. BY <br />PLANS CHECKED BY <br />pttf r) <br />APPR. FOR IS-,UANCF. BY <br />L..G . <br />) I <br />