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APP.I.ICATION FOR everetl <br />the <br />11)f'e'4'eP" CI,NSTRUCTION e <br />�rn'ov <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 - <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ID.PLUMBING PERMIT NO. <br />MAIL ADDRESS CITY ZIP PHONE <br />/•/ r! /✓�' C a LCUPv <br />ARCIIIIECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE M <br />MECHANICAL CONTRACTOR MAIL ADDRE5i CITY ZIP PHONE LICENSE F <br />223,ri:T -BiY-TE S/-22yBA <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />[�c'77e1 flcrnrkezo /2722 .29�/V E S ;Hc 9R'/25 3G1—G?5L <br />CLASS OF WORK <br />❑NEW ❑ADDITION IQALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑OUILDING RELOCATION <br />VALUATION OF WORK <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT BLOCK -OF <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 AUTHORIZED AGENT DATE <br />r <br />JOB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND, UNRS—FIT'. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BASIN) <br />OOILEftS—H.P. EA <br />FIRED A.C. UNITS —TONNAGE EA <br />SHOWERGAS <br />KITCHEN SINK 6 DISK <br />FORCED AIR SYSTEMS—B T.U. M EA <br />DISWMHEft <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />� <br />o •• k <br />SUBTOTAL <br />SUB TOTAL $ <br />PERMIT <br />S <br />PERMIT i <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RkCEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DW.:LLING UNITS <br />BUILDING <br />S <br />51ZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERSREQUIRE <br />MECHANICAL <br />OYES ONO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 101(a) <br />2. BUILDING PLANS <br />TOTAL <br />I. FIRE HYDRANT <br />4, FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) TH15 IS YOUR PERMIT <br />5. GRADINGIEXCAVATION 8 CLEARINGIGRUBIHNG <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />c <br />9-1.79 <br />