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[lie E-ve�gr«„ AP&p,L�ICATION FOR evereH <br />CPTllol CWNSTRUCTION S <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES. <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION Cl BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS CITY ZIP PHONE _ <br />Purdy's 1512 . Broadway St. Everett We. (Everett Mall) <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP - PHONE <br />GENERAL CONTRAC70R MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />Puget Sign Co, Inc. 2012 State Street Bellingham, We. 96225 733-6491 H-1793 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICLNSE, <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 1 <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE nSIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK ��Yr� <br />f $;*00.00 <br />DESCRIBE WORK <br />T ...1:..:.I,,..T D7aa+tF• 7nttara with remote transformers <br />.-V- V <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE OF BUILDING <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPIRTY(SHOWN BELOW OR ATTACH FOUR <br />COPIES) <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT BLOCK -OF <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 />'Z zi31 <br />JOB; OR <br />�5 <br />X <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET JOLIET) <br />AIR COND. UNITS-H.P. EA <br />REFRIGERATION UNITS—H. P. EA <br />BATHTUB <br />I.A VATORY (WASH BASIN) <br />BOILERS—H.P. EA <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />SHOWER <br />FORCED AIR SYST' MS— B.T.U. M EA <br />KITCHEN SINK & DISP. <br />WALL HEATERS—B.T.U. M <br />DISWASHER <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DYERS <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—RAINLEADFRS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL <br />SUBTOTAL IF <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />SIDE YARD SETBACY <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO. <br />ISE ZONE <br />LOT AREA <br />VACANT S1TE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />TYPE OF CONST. <br />OCCUFANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />12�saa <br />I <br />OC <br />SIZE OF BLDG. <br />NO. Of STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />HE DROOMS <br />FIRE SPRINKLERSREQUIRED <br />MECHANICAL <br />❑YES ONO <br />APPROVALS <br />BY <br />DATE <br />nTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.0 <br />SEC. 303(al <br />TOTAL <br />^L <br />Oil! <br />2. BUILDING P, ANS <br />3. FIRE HYDRANT <br />4, FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY IIALIDATED (I THIS SPACE) THIS 15 YOUR PERMIT <br />5. GRADINGIEXCAVAT ION& CLF ARINGIGRUBBING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />