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1A4 <br />the EY.rpnRR APPLICATION FOP`. <br />CITY OF CONSTRUCTION La <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑C MBINATION BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />MAII ADDAI SS / ZIP PHONE <br />,'1 rip �A-.-) vcla y/C� N�nd/!Sl'�YF:CI 5'���m <br />ARC ICE ICE OR DISILNHt <br />MAIL ADDRESS <br />• <br />•'• ""'^' <br />4Ef`nlRApCONTRACIOR <br />9Tn/.s, ^ 8 ffo <br />MAIL ADDRESS <br />P/l anpy Trc <br />CITY <br />ZIP PHONE LICENSE F <br />MI CHANICAL RACIOR <br />MAIL ADPIUSS <br />CITY <br />ZIP PHONE LICENSE E <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE E <br />❑NEW ❑ADDITION WALTIERATION ❑REPAIR ❑DEMOLITION LIFENCE LISIGN UGARAGE UBUILDING RELOCATION <br />VALUATION OF WORK ' <br />IF 121)o - <br />O{u{CRI01 WORK pp f'7 W <br />U.il I. _ l _/I /_ f'_t_ 1.1/'hi /" ."/c/vN r.9n10 <br />PROPOSE DUSE 01 BUIL ING <br />col I 'e / llej �fh8Y/1E0 ✓ 47Y'OCS5 ly_S/0/ 2 <br />LEGAL DESCRIPTION OF PRO RTY ISHOWN BELOW OR(PA7ACH tpuR Pits) <br />LOT _BLOCK-O• <br />_ <br />£LI r1 •'e <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. ' f — C?/ <br />SIGNATURE Of CONTRACTOR OR AUi D AGENT ATE O <br />, <br />x <br />a <br />�01 V_17"1 I' L -: !C /9 y v'F r'ti <br />103 ADDRESS <br />r <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOOLE) <br />AIR COND UNITS —HP FA <br />BATHTUB <br />REFRIGERATION UNITS —HP EA <br />LAVATORY (WASH BASIN) <br />r <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALL HLA`ERS—BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER MAIER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERVICE-BAR, ETC 1 <br />SUBTOTAL <br />SUBTOTAL 6 <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL <br />Fit S <br />SIDE YARD SETBACK <br />SIR[FT SETBACK <br />RULE YA0.05f JACK <br />PLAN CHECK N UBH IT <br />x <br />N FEE �Pp <br />CHECK FEE <br />RECEIPT'NO <br />.� <br />USE ZONE <br />LOT AREA <br />VACANT SjTE <br />ES <br />❑YO <br />/F!S <br />VALUATION <br />fEF <br />TYP'E�O f%CONST <br />•= <br />OCCUPANCY GROUP <br />O - 2- <br />NO OF DWELLING UNITS <br />BUILDING <br />IF <br />IL <br />SIZE OF BLOC <br />I <br />NO OF STORIES <br />I <br />MAX OCC LOAD <br />/ 3 <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES D <br />MECHANICAL <br />cc <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />E ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC )OXa) <br />Z BUILDING PLANS <br />TOTAL <br />I FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRADINGIEKCAVATIQN&CLEARINGiGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERTY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />•]Uf3Jcr �U <br />6 DAAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPLE FOR ISSUANCE BY <br />