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�TMaro '" ApON'TRUCTION �YeE�tt <br />everett PERMIT e <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />MAIL ADDDRESSSS �7 1 CITY l ZIPr [HONE <br />7O L'92�e'L'Jr./(1 /l/l �Lh'_ �/ L?/..L�% ✓�.>:0 —777� <br />ARCIIITIC T OR D[SICNIR MAIL ADDRESS CITY ZIP [HONE <br />SC•It! �' �.. <br />GENERAL CONTRACTOR MAIL ADDRESS CITY TIP PHONE LICE NS[1 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY LIP PNGN[ LICENSE IF <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />❑NEW ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK / <br />E <br />9DOD =` <br />DESCRIBE W)RK J. Ti � :/ L'_ V / n / Py r1 / ^ -/n" E. 60 n , <br />cfn 24 /6-AT ..cT -101 r <br />-oc - 'I <br />... ... .. - <br />I HEREBY CERTIFY THAF I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE OF BUILDING <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />k't5 al/r 2`r <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />IE GM OE SCRIPPON OF PPOPE Air ISIIOWN BIION OR A tACIUOUR COPIES) <br />i v <br />PROVISIONS <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />/� .L'n-(•r' / <br />101,� <br />BLOCK � �_OF <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 />c �j <br />ICJ z;,,/. <br />)G�G: <br />'errl/ <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X T 4Yc IUnr fJc' r <br />IOB ADDRESS <br />/ r <br />PLUMBING 0 E1 <br />MEC ANICAL <br />NO. TYPE OF FIXTURE <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER rLOSET(TOLIET) <br />AIRCONO UNITS -HP EA _ <br />REFRIGERATION UNITS-H P EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />GAS FIRED AC UNITS -TONNAGE FA <br />SHOWER <br />FORCED AIR SYSTEMS-B T U 'M EA <br />KITCHI N SINK A DISP <br />WALL HEATERS-B I l' M <br />D15WASHER <br />LAUNDRY TRAY <br />UNIT H[AT[RS-BTU M <br />CLOTHES WASHER <br />3VENTILATION <br />EVAPORATIVE COOLERS <br />WATER HFATEk <br />CLOTHES DRYERS <br />FAN <br />URINAL <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 8 CP'MNFY <br />SINK [SERVICE -BAR, ETC) <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD S[ TRACK <br />STEEL FT SETBACK <br />RI AR YARD 51 TBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />��� <br />�• <br />1 L <br />FEE ..�:$ <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT jliE <br />FEES <br />VALUATION <br />FEE <br />•2I <br />❑YES XNO <br />TYPE O C NS <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />—3 <br />If <br />NO OF TORIES <br />MAX OC�AD <br />6xZ4/ 4 <br />PLUMBING <br />FIRE ZONE <br />BAFMNT� <br />FIRE SPRINKLERS <br />D <br />M[f:En NlCAI <br />—� <br />O <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PINA[TY <br />UBC <br />SIC 1lIXI) <br />TOTAL <br />Z BUILDING PLANS <br />] FIRE HYDRANT <br />4 FIBE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGIIXCAVATION S CIE ARINGIORUBBING <br />b DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />Lam. <br />