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APALICATION FOR S <br />Thlr Emigro In \ ! everetl <br />CITY OF CONSTRUCTION', F � �.,,, e <br />everett PERMIT Y, .. <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 _ <br />EVERETT, WA982U7 []COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />ADDRESS /+ CITY 1 ZIP PHONE <br />A`•r-(I�-'`WGGlr1 +wli. CU.CrG..L l�O wrY Za,G��Y' <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRAC I OR MAIL ADDRESS k CITY ura Ca �J-�1w�a u.•••• <br />(-USA-)1., 10.0'-1►52 7-1%c0 a� 1,10"e-uuve'e ✓632T�j <br />MICHANIG\l CONTRACTOR ll MAIL ADDRESS CITY ZIP PHONE LICENSE M <br />PI l�A1BING CONt^•.: TOR MAIL ADDRESS CITY ZIP PHONE LICENSE s <br />C I US OF WORK <br />❑NEW ❑ADDITION ISALTERATION ❑REPAIR ❑DIMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />\&LLIAIION OF WORK 60 <br />I 5"t:F.4DOo <br />Ill SC RIDE \\'ORK <br />PROPOSED UST OF BUILDING <br />_ <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 />SIGNAT LIRE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />a <br />X <br />LEC L D:SCRIPIIONOF PROPERLY SHOWN RELOW OR ATTACH FOUR COPIES) <br />LOT _BOCK —OF <br />ION ADDRISS ' <br />irdiA-9= 5 tr 3'Tr Lam- rO n+-(Q LAa, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />( <br />WATER CLOSET (TOLIE^, <br />(1 <br />op <br />AIR COND UNITS-H.P EA <br />C CJ <br />BATHTUB <br />REFRIGERATION UNITS-11 P EA <br />I <br />LAVATORY IWASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED A C 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 />I <br />WATER HL,ATER <br />CLOTHES DRYERS <br />URINAL <br />DRINKING FOUNTAIN <br />F <br />VENTILATION FAN <br />RANGE HOOD <br />If,0 <br />n <br />UO <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F M. <br />VACUUM BREAKERS <br />STOVE <br />�. <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE-BAR.ETC I <br />C <br />G , <br />r— <br />SUB TOTAL <br />I'Z <br />OG <br />SUB TOTAL $ <br />I <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />s <br />(.� <br />�� <br />TOTAL FEE s <br />SIDE YARD SF BACK <br />r/ <br />"II^ <br />STREFT SETBAFK <br />NIA% <br />REAR YARD it TBACK <br />�"/ <br />PLAN <br />/CCHICCK NUMBER <br />/ "✓_ L <br />PLAN <br />FEE 19.1 .�yZ <br />CHECK FEE <br />REffIPOTrN�O. <br />�,•O <br />USE ZONE. <br />G—' <br />LOT AREA <br />VACANT SITE <br />DYES KNO <br />FEES <br />VALUATION <br />FEE <br />TYPF ONESIi1 <br />.'V <br />OCCUPANCY GROUP <br />S- 2- <br />NO OF DWELLING UNITS <br />BUILDING <br />S 5.0,ccy o <br />I e- <br />SIZE n OF RLDG <br />F� <br />& / S SQ T--rI <br />NO OF �T ORICS <br />h1AX OCC LOAD <br />PLUMBING <br />f <br />FIRE ZONES <br />2 <br />� <br />BASEMENT <br />L O <br />/�'1 <br />IIIURUOMS <br />. 1O <br />�V <br />FIRk SPRINKLERS <br />F ]UIRED <br />11ES PNO <br />MECHANICAL <br />APPROVALS <br />FIT <br />DATE <br />OTHER <br />T ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />$EC 303(a) <br />Ao, <br />2 BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />4 FITE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN MI PROPS AT VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />_ <br />S GR LDINGIE XCAVMION IS CLEARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMf NTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />V. /J <br />AFOR ISSUANCE BY <br />