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AP:r16CATIC)N FOR <br />l�s Ewrpresn �� �J ST R U CT I O N eY� <br />CITY OF <br />everett PE�MIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />❑TY HALL 259�8745 <br />EVERETT, WA9B201 ��OMBINATION ❑ BUILDING ❑ME�HANICAL ❑P:.UMBING PERMIT NO. <br />O\Yf:ER MAII AUf1X155 CIiY ZIP PIIONE <br />Ev��eeTf sv2�k= G`io8' CVER6RFG,t1 u�Y E✓!T c-�� qS1o�} <br />eRCHIIICTORp!$ICNIp M11nILApDRISS CIIY 21P PNONE <br />GlN[PAl COuiNn[i0R n�All �ODRl55 CIiY ZIP PMONF L¢fNSF I <br />S�G4. /Y' - �'O <br />LfLiKKY.U60NC0 YwG 2/C2') L/�G�l L�NN W14 9frolG 776t8tJ .Tc.c. BR RR yNZW7_� <br />n�tfMAnICAI CO�+iFnC10N MAII �DORI55 CIIY LIP PIIONE IICENSF I <br />fIUUqIN�1 CUNIR�CIOR mAIL AOORI55 CIiY ZIP PNONE IICENSE 1 <br />❑ U\ Of NONK <br />❑NE�Y ❑ADDITION <br />� vi�+nnn or �eoaa <br />+ `�S"�• °s <br />UI>i Hilll 1vORR <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑OUILDING RELOCATION <br />ruiirnaoi�si or nunuu+c <br />Gry...wre�c�x-.sc. S.�tsN. <br />IILnI [115CMIP110N O! PROPIRiv �SHOK'N pFIOW OR e1tACH {OUR [OPIFSI <br />l01 �_PIOC��Of <br />ION �Df1RK5 <br />G yoY Gst/Ys26Yz�3v=� <br />PWMBING <br />NO. TYPE OF FIafURE <br />BATNtUB <br />UVATORY iWASM [1A <br />SMOWfR <br />KIiCHCN SINA R DISP <br />DISWASM[R <br />UUHDRI' TRAY <br />CLOTHES WASHfR <br />WAT[R NEATER <br />DRINKIVG <br />VACUVb1 OREAKERS <br />ROOF DRAINS—RAINLEAD <br />SINK ISFRVICf —OAR [TC 1 <br />SIDF YAND SETIIACK <br />USE ZONE <br />TYPE OF COnST <br />SIZE Of �L�G <br />SUB TOTAL <br />PERMIT S <br />TOiAI FEE 3 <br />LOT AREA <br />OCW�ANCY GR� <br />NO OF STORIfS <br />APPROVAlS <br />1 ENVIRONMENTAL CMECK LIST � <br />7 BUILDING PLANS <br />) FIRF HYDRANT <br />i FIRE PROTfCTION SYS/FM <br />5 LRADINLIt%CA�ATIONAQfARING/GRUNHING <br />6 DRAINAGE <br />7 ENVIRONMfNTALIMPACTSTATEMENi <br />B NEALTII DISTRICT <br />APPLIUTION AGC BY __.PJJ�PlS GHECK{.D DY <br />9-i-79 <br />:j'ti ST �/u� <br />I HEREBY CER�LIFY THAT I HAVE READ AND EXAA!1VED THIS AP- <br />PLICATION AND KfJOW THE SAME TO BE TRUE AND C.ORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES COVERNING THI$ TYPE <br />OF WORK WILL 8E COMPLIED WITH WHfTHER $PECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DGES NOT PRE�UfviE TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFOR�'�1ANCE OF CONSTRUCTION. <br />SICNn7URE OF CONTRACTOR OR AUTHORIZFD AGENT DATE <br />FEE <br />RUR YARD SfTOACK PLAN <br />VACANT 517E <br />❑YFS GNO <br />NO Of DWEIUNC UNITS <br />MAH OCC LOAO <br />FIRE SPRINKLERS <br />NEQUIRED <br />C]YFS f]NO <br />EY DAiE <br />FORI$$UANCE <br />TYPE OF EQUIPME <br />AIR COND UNITS—H P. EA <br />REFRICfRATION UNITS—HP EA <br />GAS FBCD AC UNITS—TONNACE EA <br />fORCED AIH SYSTFMS—B T U M <br />IVALL HEATERS-0 T U M <br />UNIT HfATERS—pl U M <br />fVnPORAiNECOOLEftS <br />CLOTH[5 DRYFRS <br />VfNiILATION FAN <br />RANGFHOOD <br />AIR HnNDLINC UNIT— C F M. <br />SiOVE <br />61FTAL FIRfPLAf.E S CHIMNEY <br />SUBTOTAI i <br />PERMIT 3 <br />TOTALfFE S <br />NVM9ER PLAN CHECK FEE <br />FEE I RECEIPT NO. <br />FEES VALUATION FEE <br />BUILOING s /% �� � <br />•r <br />PWMOINC <br />MECHAVIUL <br />OTH[R <br />PEHALTY U BC. <br />SEC. 30)(al <br />TOTAL <br />PERMIT VALIDATION <br />\YHEN PNOPERLY VALIOATED (IN THIS SPACE� THIS IS YOUft PCRMIT <br />�l- (1i-t�D "'"CY <br />,SlCaa./ �,dz�r� � P�.r�c.�a <br />/� MGN�1-�/LC.IM O� ��-�- <br />��QElhn wl��..C.. <br />