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�» <br /> � Ai'PLICATION FOR <br /> ' � mE°�°M� COfNSTRUCTION ��e <br /> ' eVerett PERMIT <br /> �.'� DEPT. OF COMMUNITV DEVELOPMENT $ERVICES <br /> , CITY HALL 259�8745 <br /> EVERETT,WA9B201 ��OMBINATION ❑ PUILDING ❑MECHANICAL ❑PLUMBING PERMIT NCl. <br /> ' ' OWN[P � M�II nO0MR5 Cliv ZIP PHONE <br /> � .�I��C�h,n�t�r`S �✓- ?�00 1/CQ Y�U U1 y C V ,R�T- - <br /> �PCHI1tCTORD[SIGrvfN nu1Ln00R155 ❑lY ZIP PHONC <br /> "I GM0.�lCONiNACiO0. M�IlA00RE55 CIIY 21P PHON[ IICEHSt� <br /> ; S�.SS�q►�m i �iqo S-�,� AvFi�o SFam� 4 �133 `�C�so2�� �s�s�-�c-��� <br /> � n11CN�NICnIfOVINnC10R MAllnp0R65 Ci1Y LIP PMON[ IICENSf� <br /> � <br /> � PIOMpItiCIONTq1ROR M�II.AODR(55 CIiY ZIP PHONF UCEHSF� <br /> f � <br /> l I N Of\\'ORK <br /> I � �NEN' ❑ADDITION ❑ALiE2AT�ON ❑REPAIN ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br /> ' ��ui�nrinN�rwoax � <br /> � ' I �DD � . <br /> ' � U11lXIP1 N'ONC yn � <br /> � ��-�M.�,rr.Q.Q c�AJe f i�Q£ 5�N1ND� wG 5��� U� [i�a�) �LDT Si tJ - .��°,��d� <br /> reovouovsf oi xmioi�vc � I HER[BY CERTIFY THAT I HAV NEAD AND EXAMINED THI$ AP• <br /> ' � PLICATION AND KNOW THE SRME TO BE TRUE AND CORRECT ALL <br /> � �If.nl �iiCNiPllONO(PROPIRiv(SMOwNP[IOv:ORn1t�U11WRCOPi151 PROVISIONSOFLAWSANDORDINANCESGOVERNINC '(HISTYPE <br /> � �. OF WORK WILL DE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> ioi nioc._os OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �NY OTHFR STATE OR LOCAL LAW REGULATING CONSTRUCTfON <br /> i ' OR THE PERFORMANCE OF CONSTRUCTION. r / <br /> '. SIGNAIURE Of CONTRACTOR OR AUTMORRED AGENT DATE ,[�I�I �r <br /> � ' <br /> iux.one�ss <br /> X S 5 . <br /> � PIUMBING MECHANIUL <br /> I <br /> NO. TYPE OF FIXiURE FEE NO. 7YPE OF EQUIPMENT FEE <br /> � WA7ERCLOSF71iOLlET� AIRCOND UNITS—MP EA <br /> �� RMHiU9 RLFHIGfHATIONUNITS—NP fA <br /> LAVATORY�WASH flA51N� BOLL[RS—H P EA <br /> � SHOWER LAS��RfDAC UNITS—TONNALEEA <br /> KITCN[NSINKSDISP fOXCfDAIR5Y5iCM5—BtU N.EA <br /> � DISwASMIN \YAIL NFATLRS-8 T U M <br /> { UUNORY7Nn1' Ur111HfAT[RS—OiU M <br /> 1 . ClO7HL5 WASMEN f\'APONAIIVE COOlEHS <br /> �� WA1ER HUTCR CIOTHES�RYCRS <br /> ,�� I URINAL V(NiIUTIOM1FAN <br /> i DRINKING fOUN7AIN RANG[ HOOD <br /> ! FIOOR ORAIN AIR HANDUNG UNIT— C F M <br /> ' VANUb1 PRUKEHS S70V[ <br /> �. ROOf�RAINS—RAINLEAO[RS �1[TAL FIRCPIACE 6 CHIMNEY <br /> SINK ISERVIC!—OAR.[lC I <br /> i i <br /> � SUB TOTAL SUB 70TAL s <br /> PERAl17 S PERMIT f <br /> 70TAL FFF S TOTAI FEE s <br /> Slnf YARD SI7f1.1CK STAFfT$CTIIACK R[AR YAftO SE7[IACK PIAN CM[CR NUMUtR PLAN CNEIX FEE <br /> F[E RKEIPTNO, <br /> �� . USE ZONI �OT AR[A y���NT SITI FEES VALUATION FFE <br /> ` ❑YFS CNO <br /> � <br /> TYPF OF CONST OCCUPANCY GROUP NO OF OWFLLING UNIT$ <br /> � 6UILDING s <br /> 1 <br /> I SA.E OF OLDG NO OF STORIF$ MA% OCC LOAD <br /> 1 PlUMI71NG <br /> iIRF ZONC OASCMENI ��<<�HUU''��5 NFQUIRf'DKLfRS ti�fCHANIUI <br /> ! f7Yf5 ❑NO <br /> I A��lOV�lS EY DATF OTHfN <br /> 1 FNVIkONMLNTAL CH[CK US7 r�H^�TY UBC <br /> 5[C 101�a� <br /> . 7 BUIIDING PUNS <br /> � TOTAI <br /> ) FIR[ HYDRANT <br /> � RRE P0.0TfC110N SYSTFM PEIIMIi VALIDATION <br /> WHLN PROPERIY VALIOAT[D(IN THIS SPACE�THIS IS YOUR PfkMIT <br /> 5 GµADINf11kUVAlIONACLIARINLILRUNHINC <br /> b DR�INAGE L� / L� � <br /> J �� /^i� r.2r �_.� . .. ....� .� <br /> 7 ENVI0.0NM[NTAL IMPACT SIATEMENT ��1 `J A i� �-.�;1.:Y �;-r1: �:I � <br /> B HEAITH DISTRICT <br /> �VPLICATION ACC. 9Y �Plrl� ����BY APpR,fOR ISSUA�CE BY <br />� � G ��� t � �� <br /> _ _ e <br />