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APPLICATION FOP [161 <br />D'°"'" mCONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2S"745 <br />EVERETT.WA98201 ❑COMBINATION ❑BUILDING .KMECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADORISS Coll LIP PHONE <br />Y.�/<.� (3{,,�Tw Y/0 13c+-TY 51% Co• t� ydzo3 3S5=GR+Yi <br />..,...... �. ... .....�.... MAIL ADDRI SS ❑TY 71P PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE <br />x Si-,,.. e, <br />A6•••7a <br />tIP <br />PHONE LVFNSFt <br />MECHANICAL CONRACTOR <br />MAIL ADDRESS <br />CITE <br />G. <br />HUMPINCONTRACTOR <br />MAIL ADDRI SS <br />CITY 21P <br />PHONE LICENSE I <br />CLASS OF WORK <br />❑ALTERATION ❑REPAIR <br />❑DEMOLITION ❑FENCE ❑SIGN <br />❑GARAGE OBUILDING RELOCATION <br />❑NEW ❑ADDITION <br />VALUATION GI WORK <br />S <br />WORK <br />1, 2„,rrTl F+ rr, liY.4 1A'. r s� <br />PROPOSM US[ OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY ISHOW N BELOW OR ATTACH (OUR COWS, <br />LOT BLOCK Of <br />TOP ADORUS <br />rr <br />PLUMBING _ <br />IS <br />FIRE ZONE <br />RS <br />ETC) <br />1 SE <br />AnwVAIS <br />1 ENVIRONMENTAL CHECK LIST <br />Z BUILDING PLANS <br />I FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />S GRADINGIIK(.AVATIONRCEEARINGICRUBHINC <br />A DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />BY I PLANS CHECK[ U H) <br />FEE <br />IF <br />TZAR YARD SI 1BACK <br />VACANT SIZE <br />OYES ONO <br />40 OF DWELLING UNITS <br />BY I DATE <br />APPR IUR ISSUANIE HY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECTALL <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 TO VIOLATE OR CANCEL THEOF <br />ANY OTHERORITY STATE OR LOCAL LAW REGULATING CONSTRIUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SICNAIURE Of CONTRACTOR OR AUTHORIZED AGENT DATE <br />TYPE OF EQUIPMBNI <br />AIR COND UNITS -HP EA <br />REFRIGERATION UNITS-H PEA <br />BOILERS -HP EA <br />GAS FIRED AC UNITS -TONNAGE EA <br />FORCED AIR SYSTEM'i-B T U A <br />WALL HFAIMS-B TU M <br />UNIT HEATERS-B T U M <br />FEE <br />RANGE HOOD <br />AIR HANDLING UNIT- C S M <br />s,ovt GD <br />METAL FIREPLACE A CHIMNEY <br />SUS TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />PLAN CHECK NUMBIR PLAN CHECK FEE <br />FEE RECEIPT NO. <br />BUILDING 15 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />UBC <br />PENALTY SEC 70R1 <br />TOTAL ' <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />"d <br />i <br />I <br />9-1.79 <br />