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L <br />MR Ewromll <br />CITY OF <br />APPLICATION FC R <br />CONSTRUCTION <br />everett PERMIT <br />OEPT, OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT.WA98201 ❑COMBINATION <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />ev1YeH <br />Le <br />7 %%2- <br />Sim <br />GENERAL CONTRRACTOORR,� <br />MAIL ADDRESS <br />CITY TIP PHONE <br />LICENSE IF <br />MICNRMUL Cy(1'FC/�T0Y0.�"/ <br />MAIL ADJR[SS <br />CITY LIP (NONE <br />LICENSE 1 , <br />PIUMBPCG CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE 1 <br />E❑NEWWORK❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />S <br />DESCRIBE WORK <br />N U0 <br />4 <br />PROPosI <br />F of Bt{LDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />EJJ-DR PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />LEGAL DESCRIPTION OF PROPIRTY (SHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES CGVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />LOT _BLOCK —Of 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 />AIGNATU F CONTRACTOR OR AUTHORIZED AGENT DATE <br />TOR ADDRESS �//3 <br />PLUMBING MECHANICAL C... OP�`���� <br />NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET ITOLIETI AIR COND UNITS —HP EA <br />BATHTUD REFRIGERATION UNITS—H.P. EA <br />LAVATORYIWASH BASIN) HOILERS-HP EA <br />SHOWER GAS FIRED AC UNITS -TONNAGE EA <br />KITCHf N SINK A WSP FORCED AIR SYSTEMS-B T U. M EA_ <br />DISWASHER WALL HEATERS-0 T.U. M <br />LAUNDRY TRAY UNIT HEATERS-BI U. M <br />CLOTHES WASHER EVAPORATIVE COOLERS <br />WATER HEATER CLOTHES ORYERS <br />URINAL VENTILATION FAN <br />_ DRINKING FOUNTAIN RANGE HOOD <br />FLOOR DRAIN AIR HANDLING UNIT- C F M. <br />VACUUM BREAKERS STOVE <br />ROOF DRAINS -RAINLEADERS METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE -BAR. ETC 1 <br />SUBTOTAL SUBTOTAL S <br />PERMIT S PERMIT S <br />TOTAL FEE S TOTALFEE S <br />SIDE YARD SETBACK STREET SETBACK REAR YARD SEIBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br />DYES DIIO <br />TYPE Of CONST. OCCUPANCY GROUP NO OF OWFLLIHO UNITS <br />BUILDING F <br />SIZE OF BLDG NO. OF STORIES MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE BASEMENT HL DNUOMS REQUIREID SPRINKLERS MECHANICAL <br />OYFS ONO <br />AP►ROVALS BY DATE OTHER <br />1. ENVIRONMENTAL CHECK LIST UBC <br />PENALTY <br />SEC. SOXII <br />2, BUILDING PLANS TOTAL <br />1 FIRE HYDRANT <br />FIRE PROTECTION SYSTEM PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGFIXCAVATION&CLEARINOIGRUBBING <br />G DRAINAGE <br />7. ENVIRONB /ENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY MPR. FOR ISSUANCE HY <br />9-1.79 <br />9-1.79 <br />