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FM Evowro{n APPLICATION FOp <br />aTYOF CONSTRUCTION <br />everett PERMIT e <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER nv Mall ADDRESS. <br />CITY ZIP PHONE <br />T_ _ • _ _/ •RR : ,_ /1 A •• - _ <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />[NERAI CONTRACTOR <br />ere}1 Bldrs Zqe <br />MAIL ADDRESS <br />&" IFre► ke e" <br />CITY <br />Ev�reii <br />ZIP PHONE LICENSER <br />98Aa3 3s► <br />MECHANICAL CO I CTOR <br />MAIL ADUx,SS <br />CITY <br />la _ <br />LIP PHONE LICENSE III <br />- <br />i <br />EV aIZEB 1 "pH <br />PWMgING CONTMCIOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSEE <br />CUSS OF WORK <br />�E <br />[]NEW ❑ADDITION HALTERATION ❑REPAIR ❑DEMOLITION <br />❑FENCE <br />❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />\'IF <br />4W� <br />0 ISCRIM WORKAn <br />^ %n U <br />e r o tli eroort' Lonrn • 1 <br />") <br />FROPOSED USE OI BUILDING <br />_ <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 ONTRACTOR OR AUTHORIZED AGENT DATE <br />1 <br />X <br />LEGAL DISCRIPIIONCH PROPERTY(SHOW'N BELOW OR ATTACH TOUR COPIES) <br />LOT _RIOCK__OF <br />I R DURI SS <br />IF <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WAIT R CLOSE I(TOIIFII <br />AIR COND UNITS -HP IA <br />BATHTUB <br />RURIGERATION UNITS -HP EA <br />I AVATORV (WASH BASIN) <br />BOILERS -HP LA <br />SHOWER <br />GASFIRFDAC UNITS-IONNAGEEA <br />KIICHEN SINK { DISP <br />FORCED AIR SYSTEMS-8 T U M EA <br />DISWASMER <br />WAIL HIAIERS-BTU M <br />LAUNDRYIRAY <br />UNIT HEATIRS-BTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOIERS <br />WATER HUTER <br />rypTHf S DRY[ RS <br />URINALVI <br />NTILAT ION FAN <br />DRINKING fOLINTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C FM <br />VACUUM BRF AKI RS <br />STOVE <br />ROOF DRAINS- RAIN)IADF TIES <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR. EEC) <br />SUBTOTAL <br />SUB TOTAL f <br />PERMIT S <br />PERMIT { <br />TOTAL FEE S <br />TOTAL FEE { <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD S1 TBACK <br />PLAN CHICK NUMBER <br />PLAN CHECK FEE <br />Fit RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SIT[ <br />❑YES CNO <br />FEES <br />VALUATION <br />FEET <br />TYPE Of CONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />BUILDING <br />S (y <br />SIZE OF flLDG <br />NO Of STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />HI OR(N)KI5 <br />FIRE SPFINKUIRS <br />REQUIRED <br />❑YES .iN(i <br />MECHANICAL <br />A►PBOVALS <br />BY <br />DATE <br />OTHER <br />1 INVIRONMINIAL CHECK LIST <br />NAIlY <br />B <br />SEUCC IBXRI <br />Lsz <br />2 BUILDING PLANSPf <br />J FIRE HYDRANT <br />TOTAL <br />FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACE)IH15 IS YOUR PERMIT <br />5 GRADINGIEXCAVATION{ CLEARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT SIATtMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />I= <br />9-1-79 <br />