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APFuLICATION FORthe En •. Le <br />CICYOF "° CONSTRUCTION <br />CITY OF <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2SM745 <br />EVERETT. WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL city ZIP HONE <br />rc�r7.��ii f� /%it n�ur�Nr ,f7c �./ /•K/ .�i-rn1/J'` <br />ARCNI15Cl�OR O SICNIR JRAIL ADDED SS CITY 71P PHONE <br />A <br />CENTRAL CONTRACTOR MAIL ADD RISS Ci �2 /^ CIIY ZIP PHONE LICENSE I <br />�IrJ JIC /VJ r '!.A'nr� �/ o J3F'✓r�,c (�� B/. � i-rs•r 9sr.203 ?r 4::Z ? <br />PHONE LICENSE I <br />PIOAIRIM: C9NTIIACIOR MAIL ADDRISS CITY ZIP PHONE LICENSE 1 <br />CI All 111 WORK <br />❑NEW ❑ADDITION <br />Y MPMIn vDRK JD <br />�d <br />DI SA RIM WORK <br />rti, i,. �C <br />PRl1W)SID PM OI BUILDING <br />ALTERATION ❑RIPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGT ❑ BUILDING RELOCATION <br />IEGAI DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR SUM" <br />Lot �B(ock�ol <br />LOB ADDRESS <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AI•- <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 />X11/ I <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />AIR COND UNITS—H P EA <br />WATER CLOSET (TOLIET) <br />REFRIGERATION UNITS—H.P. EA <br />BATHTUB <br />BOILERS —HP EA <br />LAVATORY (WASH BASIN) <br />— <br />GAS FIRED AC UNITS —TONNAGE EA <br />SHOWER <br />y <br />FORCED AIR SYSTEMS—B 7 U M EA <br />KITCHEN SINK & DISP <br />HEATERS-8 1 U M <br />DISIVWAIL <br />UNIT HEATERS-6 7 U M <br />LAUN AUNORYT TRAY <br />EVAPORATIVE COOLERS <br />CIOTHF3 WASHER <br />— <br />CLOTHES DRYERS <br />WATER HATER <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT— C F M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE & CHIMNEY <br />ROOF DRAINS —RAINLE AGE RS <br />SINK (SERVICE —BAR. ETC) <br />SUE TOTAL S <br />SUBTOTAL <br />PERMIT E <br />PERMIT <br />f i' <br />TOTAL FEE S <br />TOTAL FEE <br />STREET SETBACK <br />$ <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER PLAN CHECK FEEFEE <br />SIDE YARD SETBACK <br />RECEIPT NO. <br />* <br />7 7s't 90l,"l <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FFE <br />DYES ONO <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDINGO <br />f � <br />— <br />— <br />SIZE OF SLOG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />I <br />FIRE ZONE <br />BASEMENT <br />NI U0.WM5 <br />FIRE pEIINNKLERS <br />REQU <br />MECHANICAL <br />DYES ONO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />PENALTY <br />LOG <br />SEC WERE <br />...— <br />1 ENVIRONMENTAL CHECK LIST <br />2 BUILDING PLANS <br />TOTAL <br />B FIRE HYDRANT <br />SYSTEM <br />VALIDATION <br />PERMIT VALIDATION <br />THIS SPACE) THIS IS YOUR PERMIT <br />A FIRE PROTECTION <br />WHEN PROPERLY VALIDATED TIN <br />S GRAOINGA XCAVAT ION& Cl I ARINCIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY7PLANSHECKED BV <br />APPR FOR ISSUANCE BY <br />91 79 <br />