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APPLICATION FOR <br />the "'° CITY OF ..CONSTRUCTION <br />CITY OF <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION 0 BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER M+II +IIORIss C111 ZIP PHONE <br />Y✓11. 1 IM., AV_.. On Eu Adj v.Ek-iK,.+l 3S� Qgos <br />MAII <br />R <br />C <br />pg <br />— _Oy­G1�IM's(:^.PoriM"P <br />8f <br />MI1I <br />r <br />MAE AOOR155 <br />CITY <br />PMI�!LICENSE S! <br />Pit %l RI+I: I: ONIMCIOR <br />MAII ADDRESS <br />Cl?, ZIP <br />NICHE LILENSE <br />❑NEW ❑ADDITION ❑ALTERATION RREPAIR []DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />1 p, ouO1� <br />DISCRIRI WORK <br />EA d <br />PROFo) 1DU;' of xL IOIND <br />5 >t J l cR a w C_ —C <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, <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />is <br />ucM DIscRIPuoN or PROPERTr IMwWN xuOW OR ATTACH IouR covnsl <br />Lol �—xLOCK �Of <br />Iox l'fj � <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />WATER CLOSET ITOLIETI <br />AIR COND UNITS — HP EA <br />BATHTUB <br />RfFRICERATION UNITS —HP FA <br />LAVATORY (WASH BASIN) <br />BOILERS-11 P EA <br />SHOWER <br />GAS FIRED AC UNITS—TONNAOk EA <br />KITCHEN SINK A DISP <br />FORCED AIR SY5TEMS—B T U M EA <br />DISWASHLR <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS—B T U M <br />CLOTHES WASHER <br />IVAPORATIVE COO FRS <br />WATER HVATER <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 —RAINLE ADERS <br />METAL FIREPLACE A CIIIMNFY <br />SINK (SERVICE —BAR. ETC I <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT <br />! <br />PERMIT IS <br />TOTAL FEE <br />f <br />TOTAL <br />FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />I RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES CNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIR[ ZONE <br />BASEMENT <br />BE GROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />FIVES [.NO <br />MIC14ANICAL <br />AP►ROVAL$ <br />IT <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHECK LIST <br />PINALTY <br />UBC <br />5F[ )OXaI <br />2 BUILDING PLANS <br />TOTAL <br />) FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S CRADINGIIXCAVATIONBCLLARINGiUUBBINC <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 />91.79 <br />