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APPLICATION 1`01 <br />CITY OF cln of CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />PHONE <br />OWNER MAIL ADDRESS <br />CITY ZIP <br />ZIP PHONE LICENSE a <br />w$YJ <br />GENERAL CONTRACTOR � MAII ADDRESS CIFY <br />(1jC7 i� l_ CO �N2C 21G2% C i=�y. C- NIA � 936 779 yga�` 6iiNzf <br />... _......,... ........ �...o /v •EJMAII ADDRE35 CITY ZIP PHONE IICENSFt <br />PLUMRI%G CONTRACTOR MAIL ADDRESS CIEY ZIP PHONE LICENSE L <br />CLASS Of WORK <br />❑NEW ❑ADDITION <br />VALUATION OF WORK <br />,C s).d� <br />DESCRIBE WORK <br />❑ALTERATION ❑REPAIR <br />,( Izecv <br />❑DEMOLITION ❑FENCE XSIGN ❑GARAGE ❑BUILDING RELOCATION <br />3V P ll�ek,S'1 N Aebollm • -F fl <br />5 a <br />I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USF Of BUILDING <br />t <br />I HEREBY CERTIFY THAT <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />M w Fin. / H E <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />_thvL <br />LEGAL DESCRIPTION Of PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT _ BLOCK _OF <br />TO VIOLATE OR CANCEL THE PROVISIONS OF <br />GIVE AUTHORITY <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFO..MANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />y <br />A <br />LOB AOD0.E55 <br />. <br />MECHANI AL <br />PLUMBING <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />FEE <br />AIR COND. UNITS -HP EA <br />WATER CLOSET (TO' 71 <br />REFRIGERATION UNITS-H.P EA <br />BATHTUB <br />BOILERS -HP EA <br />LAVATORY (WASH BASIN) <br />CAS FIRED A C. UNITS -TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS -El T.0 M EA <br />KITCHEN SINK 8 DISP <br />WALL HEATERS-O.T.U. M <br />DISWASHER <br />UNIT HEATERS-B T.0 M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C F M <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE A CHIMNEY <br />ROOF DRAINS-RAINLEADERS <br />SUBTOTAL S. <br />4i <br />SINK (SERVICE -BAR. ETC 1 <br />SUB TOTAL <br />PERMIT $ <br />PERMIT <br />S <br />TOTALFEE S <br />TOTAL FEE <br />S <br />PLAN CHECK NUMBER PLAN (HECK FEE <br />REAR <br />YARD SETBACK <br />SIDE YARD SETBACK <br />STREET SETBACK <br />FEE RECEIPT NO. <br />FEES VALUATION FEE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />TYPE OF CONST <br />OCCUPANCY GROUP NO <br />OF DWELLING UNITS <br />BUILDING S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE REQUIRED KLERS <br />❑Y'FS ❑NO <br />BY DATE <br />OTHER <br />UBC. <br />PENALTY SEC. 303(a) <br />APPROVALS <br />1 ENVIRONMENTALCHECK LIST <br />2. BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATIONWHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIE XCAVATION B CLE ARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL <br />8 HEALTH DISTRICT <br />TIMPACTTEMENT <br />APPLICATION ACCPLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />91-79 <br />