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CITY OF <br />everett <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA 98201 ❑COMBINATION <br />......•.. MAII ADD( <br />`AJ rl �p G IN a ih, 161 <br />PERMIT <br />BUILDING ❑MECHANICAL <br />nrr <br />❑PLUMBING PERMIT NO. <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE • LICENSE IF <br />IS <br />CITY LIP <br />PHONE IICENSf IF <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE E <br />CLASS OF WORK <br />❑NEW ❑ADDITION <br />ALTERATION ❑REPAIR <br />❑DEMOLITION ❑FENCE ❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK Co <br />S 5-oc <br />DESCRIBE WORK <br />PROPOSED USE OF BUILDING <br />Spac <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES' <br />LOT _BLOCK_ OF <br />108ADDRESS <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/-2 <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />AIR COED. UNITEA <br />WATER CLOSET ITOLIETI <br />REFRIGERATIONTION UNITS—H.P. EA <br />BATHTUB <br />BOILERS—H.P. EA <br />LAVATORY(WASH BASIN) <br />GAS FIRED AC UNI15—TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS—B.i.U. M EA <br />KITCHEN SINK 8 DISP. <br />WALL HEATERS—B.T.U. M <br />DISWASHER <br />UNIT HEATERS—B.T.U. 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 />METAL FIRE PIACE A CHIMNEY <br />VACUUM BREAKERS <br />ROOF DRAINS —RAINLEADERS <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL S <br />SUB TOTAL <br />FERMI? S <br />PERMIT <br />S <br />-0- <br />70TAL FEE S <br />TOTAL FEE <br />S <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />REAR <br />YARD SETBACK <br />SIDE YARD SETBACK <br />STREET SETBACK <br />FEE �3 RECEIPT NO. <br />l/ 7�53 3 s- 3 3 a-"_ 0 <br />USE ZONE <br />LOT AREA <br />A ANuTEE <br />VACANT <br />FEES <br />VALUATION <br />FEE <br />1 <br />ES <br />KNO <br />TYPE OF CONST <br />OCCUPANCY GROUP NO. <br />OF 07ELLING UNITS <br />S 2, <br />(/ <br />BUILDING <br />S S �'ytri <br />p <br />C <br />SIZE F BLDG. / <br />NO. OF S DRIES <br />MAX. OCC. LOAD <br />20 x - <br />PLUMBING <br />FIRE ZONE <br />BASEMENT BEDROOMS <br />FIRE SPRINKLERS <br />JRED <br />MECHANICAL <br />U, ONO <br />BY DATE <br />OTHER <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />LLB.C. <br />PENALTY U.11C. Xa) <br />2. BUILDING PLANS <br />TOTAL S� <br />B. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE( THIS IS YOUR PERMIT <br />5 GRADINOIEXCAVATION Sr CLEARINGIGRUBBING <br />6. DRAINAGE <br />7, ENVIRONMENTAL IMPACT STATEMENT <br />R. HEALTH DISTRICT <br />APPR. FOR ISSUANCE BY <br />APPLICATION ACC. BY PLANS CHECK/EJD 8Y <br />t/,", <br />9-1.79 <br />