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C`',.�, <br /> ,�.E�.ro,„� ApPLICAT��N FOR ���«„ <br /> °��°F .,ONSTRUCTION � <br /> everett PERII�IT <br /> DEPT. OF COMMUNITY DEVELOPMENT SERVICES , <br /> CITY HALL 259�8745 <br /> FVERETT,WA9B201 [�COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br /> WNFN MAIIAOOMF55 �M, CITY ZIP PNONE <br /> �l�r��e�e ,� f,�.-„���s /Yf/VlJcP(� " f/1�T<r fd'�� � �7��'-.r��i' <br /> AN[NITECT OR DESIGHER MAII ADDRF55 CIiY 21P PHONE <br /> GENFRAI COMNACiON Q M�II ADDRE55 CITY 21P PHONE LIC[NSF 1 <br /> -� ./�!G vr� I-�A�.�r.� e�Griyu,Y� �v�l.�K — <br /> M[[N.1NI�Al CONiRACTOR MAII�OONF55 CI1Y LIP PHONE IICENSE� <br /> PlUn1BI4G CONiqACipN M�IL ADDRF55 ❑iY ZIP PHONE llC[NSE/ <br /> CUSSOf WORK <br /> ❑NEW ❑ADDITION ❑ALTERATION ❑RFPAIR ❑fiEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br /> \'AW�i' � Of KOR� <br /> ,'j,� 'Z J� d:�\ <br /> 06CRIBE W00.N � ' a <br /> �!�_ .��n�d.�l G�; �bN � /��cNeeJ�e. ,�'� - �G? <br /> PftOPOSEDUS! or eunoivc I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> IEGAI OESCRIVtION pF PROP[R7Y�SHOWN B[lOW OP ATtA[1 fOUR COPIE51� PROVIStONS OF LAWS AND ORDINANCE$ GOVERNING THIS TYPE <br /> OF WORK W�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> io��eiocK__ov • l '���� wA "� OR NOT. THE CRANTING OF A PERMIT DOES NOT PRESUME TO <br /> L ,C�L � GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �! !r J:��O :Y G( C�u �{IC' G 0 /�✓ /t//! ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> /� i - J/ OR THE PERFORMANCE OF CONSTRUCTION. <br /> /�, �� /�yi.,, �. >-:/'N��� ��"[•� �� ���� /� 51 NATURE OF CONTRAC70R OR 1UTMO81ZE0 AGENT DATE <br /> l � <br /> 1 <br /> 109 n00RF55 ✓U�K G��v/i!Y (�"� n �'� X . �"�� / •��i� /� `',/�C <br /> �' F� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EQUIPMFNT FEE <br /> WATER CLOSET�TOLIETI ��R COND.UNITS-H.P.EA <br /> OAiHTUB REFRIGERATION UNlli-H.P. EA <br /> LAVATORY(WASH BASIN) �OILERS-H.P.EA � <br /> SHOwER GAS FIRED A.C.UNITS-TONNAGE EA <br /> KITCHEN SINK 8 DISP FORCED AIR SYSTEMS-B.T.U. M EA <br /> DISwASHER WALL HEATER$-BS.U. M <br /> LAUNORY TRAY � UNIT HEATER$-BS.U. M <br /> CLOTMES WASHER EVAPORATIVE COOLERS <br /> WATFR HEATfR CLOTHFS ORYERS <br /> UftINAL VEN71lATION FAN <br /> DRINKING FOUNiAIN RANGE NOOD <br /> FLOOR ORAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOi DRAINS-RAINLfADERS METM FIREPUCE 8 CHIMNEV <br /> SINK 6ERVICE-9AR.ETC! <br /> SUL70TAL SUlTOTAL f <br /> ►FIIMIT S ►FRMIT ! <br /> 70TALFEE f TOTALFEE s <br /> $IOF VARD SFTOnf.K STNEfT SETBACK RCAR YARD$ET'dACK PIAN CHECK UMBER PLAN CMECK FEE <br /> � ry � FFE/(a t�3 RECES�Sd� <br /> USE ZONE LOT ANEA �� <br /> VACANT SITE iEES � �AlUA710N FEE <br /> ❑YES �f10 <br /> 1YPE OF CONSIT' OCCUPA�NjCY GROUP NO.OF DWELLING UNITS <br /> �N U� �' BUILOINC s�s Q�0 // d s�/ <br /> SIZE OF BLDG h0.OF STiRIES MAX.OCC. LOAD <br /> PIUMBING <br /> fIRE ZONE BASEMENT OFOROOMS FIRE SPRINKLERS <br /> �, �_. ,�, RfQUIR D MECHANIGL <br /> ❑YES O <br /> � AP►ROVAtS er DAtF OTHER <br /> 1 FNVIRONMENTAL CHECK IIST PEN��t� U.B.C. <br /> SEC.lONa1 <br /> i BUILDING PUNS /J <br /> ) iIRE MYDRANT T�T�� / D 5� <br /> � FIRE PROTECTION SYSTEM �ERMIi VALIDATION <br /> WMFN PROPERLY VALIDATED(IN TMIS SPACEI THIS IS VOUN PERMIT <br /> 5 GRADINGIf%GVATIONdQEAHING/GRU9AING <br /> 6 ORAINACE <br /> 7 ENVIRONMfNTAL IMPACT STATEMENT <br /> B HFALTH DISTqICT <br /> AP7LIUTION ACC BY PLAN$CHEIXED BY APPR POR ISSUANCE BY <br /> VI � <br /> , <br /> g.1.79 <br />