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APPLICATION FC`R <br />me EYBf°`"" <br />CITY of CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA98201 ❑COMBINATION El BUILDING ❑MECHANICAL ]PLUMBING PERMIT NO. <br />OWNyR MAII AOONESS CITY ZIP PHONE <br />•RCHOFCT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />everett <br />e <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />CLASS <br />❑NEWWORK❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE )26SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />3 <br />DESCRI E WORK <br />Gov <br />PROPOSED USE OF <br />LEGAL BE SC RIPE ION Of PROPERTY (SHOWN RE LOW OR AT TACH FOUR COPI E S) <br />LOT � BLOCK � OF <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />WATER CLOSET (TOLIET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISWASHER <br />LAUNDRY TRAY <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS —RAINLEADERS <br />SINK (SERVICE —BAR, ETC I <br />SUBTOTAL <br />PERMIT S <br />TOTAL FEE S <br />D SETBACK I STREET SETBACK REAR YARD <br />USE ZONE ILOT <br />TYPE OF CONS) "-��^^" •'^•'•" <br />SIZE OF BLDG NO OF STORIES <br />TIRE ZONE DASEMENT BF DROOMS <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />3. BUILDING PLANS <br />3 FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5 GRADINGIE XCAVAT ION& CLEARINGIGRUBBING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT —� <br />8. HEALTH DISTRICT <br />VACANT SITE <br />OYES ONO <br />NO OF DWFE <br />BY <br />OCC <br />APPLICATION ACC. BY I PLANS CHECKED BY I APPR. FOR <br />9.1-79 <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIC''AS 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?ERFORMANCE OF CONSTRUCTION. <br />SIGNATU OF CONTRACTOK OR AVTHORIZp AJIANT DATE <br />E NO. TYPE OF EQUIPMENT ' FEE <br />AIR COND UNITS—H. P. EA <br />REFRIGERATION UNITS—H.P. EA <br />BOILERS—H.P EA <br />GAS FIRED A . UNITS —TONNAGE EA <br />FORCED AIR SYSTEMS—B T U M EA <br />WALL HEATERS—B.T.U. M <br />UNIT HEATERS—H.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNIT— C F AI <br />STOVE <br />METAL FIREPLACE & CHIMNEY <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />[BACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />FEES VALUATION FEE <br />NG UNITS <br />BUILDING S <br />ID <br />PLUMBING <br />ITS <br />MECHANICAL <br />DATE OTHER <br />U.B.C. <br />PENALTY SEC, 303(a) <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />