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TIIB Ewrgr"n APPLICATION FOR <br />DITY OF r.rO NPERM PERMIT <br />everett <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA98201 COMBINATION El BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO <br />E0. MAIL ADDRt5S CITY ZIP PHONE <br />air iJr �Ur Q� t 1^ �ELU,rr Aug- _iar._uLLwk Lt LiC¢C.TT to Q . <br />SRCHITECT OR Of ER MAIL ADDRESS CITY /I�� ZIP PHONE <br />a,j Lo 12LtL0.FJ CaaSi,Euc .�G�oAOELL(iL uA WA. gsco <br />GENERAL CONTRAC70R +' Z hC�l_I <br />MAIL ADDRESS CITY <br />n L _ ^ .. _ _ _ _ +G ZIP PHONE LICENSE / <br />F <br />"" •^ rnunt LICENS[ / <br />I <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE / <br />CLASS OF WORK <br />[ <br />I[]t4EW ❑ADDITION ❑ALTERATION ❑REPAIR [-]DEMOLITION ❑FENCE ❑ SIC; N ❑GARAGE ❑BUILDING RELOCATION <br />i _TKO F3 `y..1a 72Q 'J �.7 rZ �-r �J•c.oL uc <br />,�. PROPOSED USE OF BUILDING I SI.L Ct,."titZ, cl. rt;T`LOL; <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BILOW OR ATTACH FOI,R COPIES) <br />LOT - BLOCK -OF <br />1-�Li_IA�Ctr. QL�Ii. ST"'Z 1�- <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 T,HE-P€RFORMANCE OF CONSTRUCTION. / / <br />SIGN. Tr <br />OF CONTRACTOR Oft -AUTHORIZED AGENT DATE ! G 3 <br />IOB .S/pOR SS � L <br />OC 6 v� <br />X <br />1 1 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />Cwj <br />AIR COND. UNITS-H.P. EA <br />BATHTUII <br />- <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY (WASH BASIN) <br />406 <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK IS DISP <br />12 <br />O(J <br />FORCED AIR SYSTEMS -BTU M EA <br />DISWASHER <br />WALL HEATERS-B.T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />I <br />WATER HEATER <br />CLOTHES DRYERS <br />I <br />URINAL <br />go <br />s <br />VENTILATION FAN <br />C�J <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />- <br />AIR HANDLING UNIT-CF.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE -BAR. ETC.) <br />SUB TOTAL <br />SUB TOTAL f <br />!o <br />tTJ <br />_ <br />PERMIT 1 <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />� <br />CHECK FEE <br />RECEIPT ;/. <br />5 <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />V - n( <br />OCCUPANCY CROUP <br />I&- Z <br />NO. OF DWELLING UNITS <br />--� <br />BUILDING <br />S <br />C <br />SIZE OF40LDC A ro <br />NO. OF STORIES <br />MAX OCC. LOAD <br />PLUMBING <br />l 8 <br />Tj <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUITE D O <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U.R.C. <br />SEC. JDNa) <br />2 BUILDING PLANS <br />J FIRE HYDRANT <br />TOTAL <br />d D <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPTRLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIIXCAVATION A CLEARINGIGRUBBING <br />G. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT�-e�- <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />V, c. <br />APPR. FOR ISSUANCE BY <br />(. o(/I <br />9.1.79 <br />