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the EverBreRn <br />LITY OF <br />API _ICATION FOR <br />CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />evereH <br />e <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADORISS CITY LIP I"IOHE <br />-A- /4i/-Lae. �r 1�/v�1 �7� �Js."cs 3_S�_✓�5�7 <br />ARMIDCI OR DI LNIR MAIL ADDRESS CITY Zip PHONE <br />J�AMe— <br />LINIRAI CONIMI'IOR MAIL ADDRESS CIIY LIP PHONE LICENSE <br />_.7..6 M A:— <br />PII'SIRINL('ONTM%CIOR� MAIL ADDRESS CIIY LIP PHONE LICINSEI <br />'7 ,eMG <br />(❑NEWWORK <br />❑ADDITION ALTERATION ❑Rf PAIR ❑DEMOLITION LDFENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />Y MVAnON Dr wDRA <br />(II WRITE WoRI , <br />PROFOSHI LIST of BUILDING <br />e C_- <br />HC.AI DISCRIPTIONOF PROPIRIY (SHOWN RHOW OR ATTACH FOUR CONINE <br />101 _ stock —of <br />c ao..,6AA <br />I HEREBY CERTIFY THAT I VE HAREAD AND E%AMINED 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 />a? r 1J •e <br />/p /� <br />TOP ADDRESS <br />�/ <br />PLUMBING <br />MECHANICAL 61 <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TIOLIFT) <br />AIRCOND UNITS —HP FA <br />BATHTUB <br />REFRIGERATION UNITS —Ell P EA <br />LAVATORY (WASH BASIN) <br />> <br />— <br />'BOILERS —HP EA <br />SHOWER <br />GAS FIRED A C UNITS —TONNAGE EA <br />KITCHEN SINK 8 DISP <br />IORCID AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALL HEATERS —BTU M <br />IAUNDRYTRAY <br />UNIT HEATERS —BTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDL INC UNIT— C F M <br />VACUUM BRIAKIRS <br />STOVE <br />ROOF DRAINS-RAINLEADIRS <br />METAL FIREPIACF 6 CHIMNEY <br />SINK (SERVICE, -BAR. ETC) <br />SUBTOTAL <br />SUB IolAt 8 <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD S[TBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />rll <br />CHECK FEE <br />REC'IPT NO <br />USE ZONE <br />101 AREA <br />VACANT $III <br />OYES (' <br />FEES <br />VALUATION <br />FEE <br />TYPE /C0 ISE <br />NN <br />OCCUPANCY TOP <br />4 - <br />NO OF DWELLING UNITS <br />-- <br />BUILDING <br />S <br />IZE ,f BLDG , <br />/ <br />NO OF STORIES <br />' <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />L <br />BASEMENT <br />BI FHCE]MS <br />FIRE SPRINKLERS <br />REQUIRED / <br />nYIS ii1R5 <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHIR <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SIC 301(a) <br />2 BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATID TIN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGII XCAVAT ION A CL I ARINGIGRUBAING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />