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r <br />APPLICATION FOR <br />CITY OF �.ONSTRUCTION <br />everett PF' RM IT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVSCES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION BUILDING ]MECHANICAL El PLUMBING PERMIT NO. <br />ZIP <br />everen <br />e <br />CENERAL, CI1O(NNTTR,^RACTOR <br />MAIL <br />CITY <br />ZIP <br />PHONE <br />LICENSE E <br />1.�-,E <br />CX6)NC{` Is Cl2t4 IIt_Ll'�-M(] <br />/ADDRESS <br />(1 (� - <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE E <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />CLASS OF WORK <br />❑NEW ❑ADDITION XALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK [7L� <br />F Sim ;Ol <br />DESCRIBE WORK <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND E.',AMINED THIS AP- <br />S146E T.c PH 1 (Z <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 />LECAI DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATIACH FOUR COPIES) <br />LOT _ BLOCK —OF <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 />JOB ADDRESS <br />�OL <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIEI) <br />AIR COND UNITS-H.P. EA <br />!— <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />K,,TCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS -BTU. 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 />URINAL <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINX (SERVICE -BAR, ETC) <br />AIR HANDLING UNIT- CF <br />STOVE <br />METAL FIREPLACE S CHIMNEY <br />SUB TOTAL SUC TOTAL B <br />PERMIT S PERMIT <br />YARD <br />USE ZONE I LOT AREA I VACA <br />❑YESN SIT <br />OF <br />IZE U'F BLOG. / NO. OF <br />WE ZONE 9A1EMI <br />CHECK NUMBER <br />FEE p3 <br />'z 3 :3�— <br />FEE <br />BUILDING S U V v I S O Is <br />PLUMBING <br />—. I RE( wLp _ I MECHANICAL <br />APPROVALS BY DATE <br />1, ENVIRONMENTAL CHECK L15T <br />2, BUILDING PLANS <br />7 FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5 GRADINGIEXCAVATIONGCLEARINGIDRUBBIND <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY APPR. FOR ISSUANCE BY <br />I/ 1 �. <br />OTHER <br />PENALTY <br />TOTAL <br />U.B.C. <br />SEC.3 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />