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L <br />,�.E,�,�� APPLICATION FOR ���,� <br />`�^°� CONSTRUCTIO� <br />everett PERMIT e <br />DEPT. OF COMMUNITV DEVELOPMENT $ERVICES <br />CITY HALL 259�8715 � <br />EVERETT, WA 98201 ��OMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNlR M�II ADDN65 �IiY 21P PHONE <br />T.Q1d� 3• 'UWEn1RY ->�fo�G F7�i.�V/f_.cJ AVE. £VER.Eii 9f'Jp3 �S�-S�b� <br />ANf.HITECT OR OESIGNER M�II ApOXE55 �ITY Z�p pHpNE <br />GFNFR�I CONIR�CTOR M\Il ADORE55 CITY Zlp PHONE IiCFNSE 1 <br />� <br />Cl�SSOf WONK <br />❑NEW ❑ADDITION <br />VnWAiIONOf WORI( <br />1' <br />A OlSCRINf WORK <br />/` <br />PROPOS[0 USF OI HU IN� <br />PHONt <br />tn <br />� <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING REIOCATION <br />lEGnl �l5[RIPLIOv Of PROPF0.iY (SHOWH BEIOw 00. nTTA[H iOUR COPIE51 <br />l01 BIOCK_Oi <br />IONnUDRKS <br />k S-�t O �l <br />PLUMBING <br />NO. TYPE OF FI%TURE <br />WATFR CLOSET ITOLIETI _— <br />�oy� tw /QJG <br />IAVATORV�WASH BA <br />SHOWFR <br />KITCHEN SINK b DISP <br />DISWASHEk <br />UUNDRY TRAY <br />CLpTMES WASNER <br />URINAL <br />C.`INKING FOUNTAIN <br />/IOOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAIN$—RAINLEADERS <br />SINK ISERVICE—BAR. ETC 1 <br />USF ZONE <br />TYPE OF CON57 <br />FIRF ZOHE <br />►EIIMIT <br />TOTAI <br />STRECT SC <br />LOf AREA <br />OCCUPAN( <br />NO Of $Ti <br />ARIIO\ \l5 <br />1 WVIRONMEN7AL CMLIX LIST <br />3. BU�II�.NC PUN$ <br />) FIkE HVDRANT <br />1 FIRk PROTECTION SVSTEM <br />5 GRADINCI�XUVATIONBCIkARINC1GRUlPING <br />6 DRAINACE <br />Z FNVIRONMENTAL IMPACT STATEMENT <br />E MEALTM OISTNICT <br />APFLICATION ACC. 8Y PUNS CMECKE� BY <br />9-1 79 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION F:VD KNOW 7HE SAME TO BE ?RUE AND CORRECT ALL <br />PROVISION$ 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 />CIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAiURE OF CONTRACTOR OR AUTMORIZED AGENT DATE <br />�"T �/�.10 7( .�it� / -� 3- � <br />MECHANICAL <br />FEE NO. TYPE OF EQUIPMkNT FE <br />AIR CONO UNITS—HP. EA <br />REFRIGERATION UNITS—H.P. EA <br />BOILERS—M P EA <br />W$ FIRED AC. UNITS—TONNACE EA <br />FORCFD AIR SYSTEMS—B.T.U. M EA <br />WALL MEATERS—BSL M <br />UNITMEATERS—PTU M <br />EVAPORATIVE COOLERS <br />CIOTHES DRYERS <br />VENfILATION FAN <br />RANGEHOOD <br />AIR HAN�LING UNIT— C.F M. <br />STOVE <br />METAI FIRE7UCE 8 CHIMNFY <br />� � L <br />SU! 70TAL f <br />f PERMiT f <br />S TOTAL FEF f <br />RCAR YARD SETBAC <br />VACANTSRF <br />❑YES ❑NO <br />NO OF DWELLIWG l <br />MA% OCC IOAD <br />FIRE SPRINKLERS <br />REQUIRED <br />❑VES ❑�+O <br />er DATE <br />fOR ISSUANCE BY <br />PLAN CMKK NUMBER <br />FEF RECEIPT NO. <br />VAlUA710N iEE <br />9UILDING f <br />PLUMHING <br />MECHANICAL <br />OTMER <br />PkNALTY U.B.C. <br />SEC.30Na) <br />iOTAt <br />�f11MlT VAlIDA710N <br />WMEN PROPERLY VALIDATED (IN THIS SPACF) TMIS IS YGUR PERMIT <br />