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AWLICATION FOR "" <br />fne Everprosn evere K <br />CITY OF <br />t CONSTRUCT O �I - <br />PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 - - -- - <br />EVERETT, WA90201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWMR MAIL AOORISS SCITY PHONE <br />a?ewa�t P� [3Ox 9v7 3�Ilevvt 9644 -� <br />ARCHITECT OR DCMR MAIL ADORE SS CITY ZIP PHONE <br />3n/(� (4Aj;mCh2 Fve"11 a5q -31Co <br />GENERAL COWIRALTOR /' MAIL ADORESS rCITY ZIP PHONE LICENSEE <br />� , - Xle n Co. .300 Al 999109 143,F-115-/1 1 / <br />rNURL LICENSE E <br />S - 33lef, P89 <br />PI I IRINC CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE E <br />Cl ASS OF WORK <br />❑NEW [:]ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE SIGN ❑GARAGE ❑BUILDING RELOCATION <br />\'AWAIION OF WORK <br />,4 300, Oa <br />OI ACRITH WORK s t <br />n or 6141s.4on <br />PRON)SID I'll OF BUILDING <br />_Lk"I GY'a c Pv <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 />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 I OCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF NTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />IIGAL DESCRIPTION Of PROPIRIY[SHOWN B LOW OR ATTACH FOURCOPHSI <br />LOT —BLOCK—OF <br />/ / <br />n SC GV <br />LOB ADDRI SS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET HOLIETI <br />AIR COND UNITS -HP EA <br />BATHTUB <br />REFRIGERATION UNITS -HP EA <br />LAVATORY [WASH BASIN) <br />BOILERS -HP LA <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS—B T U. M EA <br />DISWASHER <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 />S1OVE <br />ROOF DRAINS —RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />SUBTOTAL <br />SUB 70TAL S <br />PERMIT f <br />PERMIT IF <br />TOTAL FEE $ <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />C)YFS ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC SEC. 70$a) <br />2 BUILDING PLANS <br />L FIRE HYDRANT <br />TOTAL <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />Y <br />S GRADINGIf%UVATIONBCLEARING/GRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />T NS ECKE BY <br />APPR FOR ISSUANCE BY9.01 <br />9 1-79 <br />