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. , AP�ICATION FOR �,�, everett <br />Cl�NSTRUCTION e <br />everett P� RM IT <br />DEPT. OF COMMUNITY DEV[LOPMENT SF.RVICES <br />CITY HALL 259�8745 <br />EVERETT,WA98201 �COMBINATION �-BUILDING ❑MECHANICAL ❑PLUMBING PERM17N0. <br />O\1'4fN M1IAILAUUHISS / CIIY lIY PIIO4E <br />C E Gi.�/G/-1 T �j2 —9 y���� Ec/h�a'r��5 ��� y PU7.�' 77,6 cPc.j <� <br />na[r1lTccl oN oE51f.NFN ntnll n�oNtss tlir Lr rllorvE <br />Jo�ih Fsc/c,- a�(CEL�/.�/f �/ :/ �� i/ <br />GFukNALCONiNAC10R � M,1ILAUDR65 U1Y LIP PHOUE LIC[NSfp <br />�i�J�C� /�lI✓ f�'n�sT,�j�' s�.�C -/9G S�� ;.�.���w-<��.(�U: 4P�°jc• ��t' iPP% <br />.VEC11ANIULCONTRAQOR MNLAU�NE55 LIIY LIP PIIONE LICENSEp <br />PWMIIINGCONTRACiOH M1IAILAD�NF55 CIIY ZIP PIIONE LICWSE/ <br />CUSS OF \VORK <br />�'EW ❑ADDITION ❑ALTERATIOK ❑REPAIR ❑DEMOLITION ❑FENCE ❑SICN ❑GARACE ❑�UILDING RELOCATION <br />VAIUATION OF \VOftK C �. <br />, �c,,��,o � <br />utscemE woa� <br />Cre�f /l�e:� vroe,re h'/�(� <br />ranmcrnuanrnmmwr. . I THISAP <br />lf WL DESCNIPTION Of PROP[NTY � <br />ior `fys;.� oiocK 5 0� <br />'�'`S41 _7s� /-nY3 <br />�-*C. ,' <br />ionnooaess <br />C'-Tr,r�- <br />PLUMBING <br />c, ,� f � /c�Hisf <br />HO\G�FLOW OR ATTA[N FOUR CO�IFS��/ <br />. � 47�f'.^ci 7�y !I r�n � <br />, � C'i i7 •7 � �� <br />� — <br />�- 28-d- <br />>i <br />� G'c'r i/' Pc'i/ C/ ' At J <br />NO. I TYPF. OF FI%TURE <br />EIATHTU� <br />IAVATORV pVASH <br />KITCHEN SINK R DISP. <br />DI$\4'ASHER <br />UUNDRV TRAY <br />CLOTHES WASHER <br />1VATER HEATER <br />UNINAL <br />ORINKING FOUNTAIN <br />FLOOR �ftAIN <br />VACUUM Ld[AKERS <br />ROOF DRAIN$--RAINL[ADERS <br />SINK �S[RVICE-6AR ETC.1 <br />SIDE YARD SETI3ACK <br />itJ ' <br />USE ZO`lE <br />G-/ <br />Trn�F9rcoNsl. <br />� <br />SIZE OF ULDQ � <br />��-'JC� cO St�/r�� <br />FlREZJNAE ! <br />L <br />I HERE6Y CERTIFY THAT� I HAVE READ AND EXAM NED - <br />PLIC�TION AND KNOW THE S�ME TO BE TRUE AND CORRECT ALL <br />PROVISION$ OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL 6E COMPLIED N'ITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTi;� RIT`! TO VIOLnTE OR CANCEL THE PROVISIONS OF <br />ANY OTHER SinTE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE �Z 'J-7y <br />i� <br />Y �1.,�',�%, :. /� <br />IS[[97G1:1PL1� <br />FEE NO. TYPE OF EQUIPMENT FEE <br />(>b /,lR COND. UNITS-H.P. EA <br />RF(RIGERATION UNITS-hLP. EA <br />f1011 ERS-HP. EA <br />GA$ fIRED n.C. UNIT$-TO4NAGE EA <br />FONCED AIN SVSTFMS-f7.T.U. M EA <br />\VALL HEATEHS-6.i.U. M <br />(=d UNIT HEATIBS-07.U. h' <br />f VAI'OHATIVE COOLERS <br />SUB TOTAL - � <br />PERMIT S <br />TOTAL FEE f <br />STREETSETOACK REAHVARU SFTUACK <br />7S i �s-/ <br />IOTAREA � VACANTSITE <br />y}� �i�` Si� �es ❑No <br />, �� � <br />OCCUPANCY CR UP NO. OF ON�LLIhG UNI <br />�� Z ry� <br />NO.OFSTORIE$ MA%.VCC.LOAD <br />OASEMENT IILDNJnA15 FIkE SPRINKLFNS <br />RLQUBCD <br />� � � rlt: C QNO <br />APPRO�' i <br />L EN�'IRONMENTAL CH[CK LIST <br />i. GUII�ING PLANS <br />3. FtRE H�DRANT <br />4. FIRE PROTECTION SYSTEM <br />5. CRAUING!IXGIVATIGN 8 QFAftINGGNU13111Nf, <br />�. oRniNnc[ <br />,-. ENVIRONAIENTAL Ih1PACT $iATEh7ENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC 111' <br />V[NTILATION <br />RANGEHOOD <br />AIR HANOLING UNIT- CF.�V. <br />STOVC <br />METAL FIREPLACE R CHIMNEY <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />PUN CHLCK NUM[1ER PLAN CHECK FEE <br />QO� !EE RECEIPTNO. <br />6 0 S�- �� <br />F[ES VAWAiION FEE <br />ounoiNc i 5 <br />PLUMIIING <br />.�1FCHANICAL <br />9Y I- DATF I OTHEN <br />e��Ns criecKeo ov � nrre roa issunNc� nr <br />NG.i7* <br />PENALTY U.li C. <br />SEC.701(a) <br />TOTAL I I z <br />PERMIT V.ILIDATION <br />1vHEN f'R(IPERLY VAIIDAiED (IN THIS SPACE; THIS IS VOUR PERMIT <br />�D L'.S'iton�C ��3��y ^ (� R j7 R <br />��/vJJ�:.r-�v, � � ... �:��,..:`i�^t� V L711 V LSD <br />. � r UU <br />DEC 0 3 1979 <br />GIiY OF EVERETI' <br />t.r.s����,�a� �}�p� <br />