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k _'PLICATION FOR <br />� O'°"'" CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.874S <br />EVERETT, WA98Z01 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING <br />OWNlR /� M II A'�'15S ' <br />e jr, 71 Aar <br />PERMIT NO. <br />NPAIRINf1CONTRACTOR MAIL AOORISS City ZIP PHONE LICENSE <br />C I Aft Of WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑RI PAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE OUIIDING RELJCATION <br />SMUATIONOI WORK <br />S <br />ITT SI WO A� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />rROwAO vit Of RI <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />IIC.AI OISCRIPI1ONOF PROHRTYISHOWN RIIOW OK ATTACH TOUR COPHSI <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />till ___RHxK__OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR T F FORMANCE OF CONSTRUCTION. <br />SI ATURE OF NTRACTOR O HOR ZED AGENT <br />rDATE <br />lox Ann IAt <br />�. <br />2 ✓tr� C <br />4 <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE Of EQUIPMENT <br />AIR CONEUNITS—H P EA <br />WATER CLOSET ITOLIETI <br />REFRILE RATION UNIT$—H.P fA <br />BATHTUB <br />BOILERS—H P EA <br />LAVATORY (WASH BASIN) <br />GAS FIRED AC UNITS—TONNAGEEA <br />SHOWIR <br />VIAFORCED <br />AIR SYSTEMS-5 T U <br />K ITCTR SINK 6 DISP <br />WAIT EATl R$—BTU M <br />WALLH <br />DISWASHER <br />UNIT WATERSB T U M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CEDARS DRYERS <br />CLOTHES WASHER <br />WAIfR HEATER <br />VENTILATION FAN <br />URINAL <br />RANG( HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— C f M <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />SIOVf <br />METAL FIREPLACE 8 CHIMNEY <br />ROOF DRAINS—RAINIE ADE ITS <br />SINK ISE RVICL —BAR. ETC 1 <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT S <br />►ERMIT <br />S <br />. <br />TOTAL FITS <br />TOTAL FEE <br />S <br />PLAN CHECK NUMBER PLAN CMTEE <br />IPT NO <br />RECEIPT <br />SIDE YARD SETBACK <br />SIRF[T SETBACK <br />REAR YARD SETBACK <br />III <br />USE ZONE <br />LOT AREA <br />VACANT SIT[ <br />I[ES <br />VALUATION <br />FEE <br />❑VI$ ,NO <br />TYPE OF CONSI <br />OCCUPANCY GROUP <br />NO OF DWf IIING UNITS <br />BUILDING <br />S <br />SIZE Of BLDG <br />NO OF STORIES <br />MIX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMINT <br />I1117HER)MS <br />REQUIREDSPRINKLERS <br />MICHANICAI <br />CIY(5 nNO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />PINAITY <br />I Bt <br />O VnI <br />1 ENVIRONMENTAL CHECK LIST <br />T BUILDING PLANS <br />TOTAL <br />I FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPLRLY VALIDATED TIN THIS SPACEI THIS IS YOUR PERMIT <br />S GRADINGIIXCAVATION A CIE ARINOIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY I PLANS CHECKED BY <br />APPR FOR ISSUANCI BY <br />