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k.'PLICAIION FOR evereD <br />the Evorg,"n GITY OF CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.874S <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNIR ,� x- jll AISS� ?/ Clll ZIP PHONI <br />/�L✓CI'd xpn�/ ! b <br />urwvrr nRmuruu MAII ADDRISS CITY ZIP PHONE <br />PII'WRING CONTRACTOR MAIL ADDRISS CITY ZIP PHONE LICENSER <br />Cl nA OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE BUILDING RELOCATION <br />s MUMIONOF WORK <br />Iry C.071— 1 — - — - <br />PMUNTVDUi1 DI RWIDING <br />OGAI DISOIIPIIONOF PROPIRC,ISHOWN RIIOW OR AITACH FOUR COPIISI <br />101 __RIocK_of <br />4r <br />62gx i'» o in u <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 T FORMANCE OF CONSTRUCTION. <br />SI ATURE OF NTRACTOR O HOR ZED AGENT DATE <br />9/a <br />FOR wnl W <br />2 ✓` ✓cr �.. � cite <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE Of FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIETI <br />AIR CONE) UNITS — HP EA <br />BATHTUB <br />RIFRIGERATIONUNITS—HP EA <br />LAVATORY (WASH BASINI <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS—B I U MIA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU M <br />CLOIHFS WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VINIILATION FAN <br />DRINKING FOUNTAIN <br />RANGE MOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLE AM ITS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />SUN TOTAL <br />SUN TOTAL L <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FIE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD St TIIA(K <br />PLAN CHICK NUMBER <br />PLAN <br />FEf <br />CHECK F(l <br />RECEIPT NO <br />USF ZONE <br />LOT AREA <br />VACANT SITE <br />OYIS CNO <br />TIES <br />VALUATION <br />fFF <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 />FIRE ZONE <br />BASEMENT <br />HI UR(%;Ms <br />FIRE REQUIRED <br />TIYfS TTNO <br />MECHANICAL <br />MlCHANICAL <br />A►PROVAIS <br />NY <br />DATE. <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC 303(RI <br />2 BUILDING PLANS <br />iOTAI <br />— <br />FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGII XCAVAT ION& CIA ARINGIGRUBBING <br />6 DRAINAGE _ <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />N HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9.1.79 <br />