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NX FLICATION FOPak <br />WONSTRUCTIONw <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER ` MAIL ADDRESS CITY ZIP PHONE <br />A.( I A <br />DESIGNER <br />MAIL <br />RW <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />21P <br />PHONE LICENSE If <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE IF <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSo p <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />❑DEMOLITION ❑FENCE <br />❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />S II—J281(pCl <br />I•! - <br />•Zrg,,av <br />DESCRIBE WORK <br />PROPOSED USE OF <br />.EGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK _OF <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 LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />Ion nooREs7s-zs <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE FEE NO. I TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOLIET) AIR COND. UNITS-H.P. EA ' �.; <br />BATHTUB REFRIGERATION UNITS-H.P. EA � K <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK 8 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 />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE S CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE $ <br />SIDE YARD Sl TBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />I I E RECEIPT NO, <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />YnLunTlDry <br />FEE <br />TYPE OF CONSI <br />I OCCUPANCY CROUP <br />NO OF DWELLE:C UNITS <br />BLDG. I NO, OF STORIES I MAX. OCC. <br />APPROVALS I BY I DATE <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />4, FIRE PROTECTION SYSTEM <br />S. GRADINGIEXCAVATION 8 CLEARINGIGRUHHING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT 51ATEMENT <br />B. HEALTH DISTRICT <br />BUILDING ( S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY U.B.C. -- <br />SEC. 303(a) <br />TOTAL 1 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />! L-i c *2 O J\- 1%0 IL_ PC_ Yar_T CHE>G 4 <br />APPLICATION ACC, BY I PLANS CHECKED RY I APPR. FOR ISSUANCE BY <br />9.1-79 <br />