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the EYerpreen APPLICATION FOR <br />CITY OF C.JNSTRUCTION e <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />CINIXAL CONTRACTOR MAIL AUDRISS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING <br />ZrP PHONE LICENSE <br />55 OF WORK <br />NEW ❑ADDITION ❑ALTERATIO/ ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ECARAGE ❑BUILDING RELOCATION <br />5'ALLNTION of WORK <br />s <br />DESCRIBE WORK <br />PROPOSED USE Of BUILDING <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 AUTHORIZID AGENT DATE <br />y <br />X <br />LICel DI SCRIPT ION OF PROPERTY (SHOWN BE LOW OR AT UCH FOUR COPE S) <br />LOT —BLOCK —OF <br />LOB AO RI SS <br />' <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOME) <br />AIR COND UNITS—H P EA <br />BATHTUB <br />REIRIGERATIONUNITS—HP [A <br />LAVATORY (WASH BASIN) <br />BOILIRS—H P EA <br />' <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />IORCID AIR SYSTEMS—B T U M EA <br />DISWASHTR <br />WALL HE ATIRS—BTU M <br />LAUNDRY TRAY <br />UNIT HIATIRS—BTU M <br />CLOTHES WASHIR <br />EVAPORATIVE COOLERS <br />WATER HEAILR <br />CLO1141S DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANG[ HOOD <br />f LOON DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />S10V'1 <br />ROOF DRAIN5—RAINLEADERS <br />MI IAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR FTC) <br />SUN TOTAL <br />SUN TOTAL { <br />PERMIT <br />{ <br />PERMIT IS <br />TOTAL FEE <br />$1 <br />TOTAL FEE { <br />SIDE YARD 511 BACK <br />STREET SETBACK <br />REAR YARD SI TBACK <br />PLAN CHICK NUMBER <br />PLAN <br />FEE <br />CHECK HE <br />R1CiIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YE5 ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE Of COAST <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 />IFDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />FTYES NO <br />MECHANICAL <br />A►FROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHICK LIST <br />NALIY <br />URICPI <br />SEC LOW <br />Z BUILDING PLANS <br />T FIRE HYDRANT <br />TOTAL <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WEAN PROPERLY VALIDATE D (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADING9 KCAVAIION 6 CIE ARINGIGRUBBING <br />B DRAINAGE <br />7 ENVIRONMENTAL IMPACT STAIIM[NT <br />{ HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKID BY <br />APPR FOR ISSUANCE By <br />