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the EYProFNR APPLICATION FOR eYN,e„ <br />Cl" OF <br />CONSTRUCTION <br />everett PERMIT e <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT.WA98201 ❑COMBINATION 21BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNIR MAIL AUURI55 CITY lip PHONE <br />2l.e_.( 1m LRe.va-FL RD p �u!9g /d 3S� g403 <br />ARCHIIICTORDISICMR MAIL ADORISS CITY ZIP PHONE <br />btn RAU VNIRU IUR MAIL AODRISS CITY z I P OF; <br />P i _ _ 2oyI CCINNSF R <br />lop— <br />ct r4 ti << a0f Z, c,N-I_Q s f 1- us Ajn�IF4 QrG % n I a_ alcu <br />♦III HANKAI IONTRACTOR MAIL ADORE SS CITY (IP PHONE LICENSER <br />PIOMRI4f. CONTRACTOR MAIL ADDRESS CIL ZIP PHONE LICENSE R <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION RREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUAi1L)4 OI WORK <br />_T I Li'a o. eo <br />DESCRIBE WORK <br />I&, V—.—�17 . <br />PRO"[" USE Of RL IOING <br />5 P }'Z¢ 5 [ cl/L n C -t <br />1 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. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE L <br />X P 7 <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATIAC14 FOUR COPHSI <br />TOT �BlaxOF t_ 1 <br />TOR AODR55Iy� <br />v Tic <br />PLUMBING If <br />MECHANICAL <br />NO. <br />TYPE Of FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />— <br />WATER CLOSET ITOLIFTI <br />AIR COND UNITS -HP EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />BOILEF PEA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP <br />IORC[D AIR SYSTIMS-B T U M EA <br />DISWASHFR <br />WALL HEAIERS-BTU M <br />LAUNORYTRAY <br />UNIT HEAIERS-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 HANDLING UN.'- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS - RAINLE ADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICI -BAR. ETC) <br />SUBTOTAL <br />SUN TOTAL f <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTALFEE <br />f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />THE RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITF <br />OYES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELI INC UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASE M[N7 <br />III OROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />FITTS C7N0 <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 [NVIRONMENTAL CHECK LIST <br />PENALTY <br />U B C <br />5EC SOAal <br />7 BUILDING PUNS <br />TOTAL <br />7 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHIN PROPI REY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S IGIADINGII XC.AVATION 8 CUARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />