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r <br />Y <br />i <br />the EYBFpnRn APPLICATION FF O P We <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS <br />COY LIP pgpryp <br />ceMe Foshr� Er 1 •12-1 Fv doe L FJ'!ceH Wm 337 -/3/1 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />Tbrrr�44-5Co.✓tT <br />MAIL ADDRESS <br />C513/7/SryrJcsc <br />CITY <br />5/^La.,U,�k <br />ZIP <br />Y6.2vo <br />PHONE <br />s•48-l4ll, <br />LICENSE R <br />/,cectr�ozyU <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />LIP <br />PHONE <br />LICENSE R <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE) <br />M,A.elLrc ?IL4»,6;,j> C� 3.)7-211q ov F,'Ie- <br />CLASS OF WORK <br />❑NEW []ADDITION ❑ALTERATION REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />S -3 3 0"D <br />DESCRIBE WORK'�FrLfF/C Mi,N.� PF •�•^b•'w <br />2+. n Rr -NAR <br />PROPOSED USE OF BUILDING <br />5 — Ple-y <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />/ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />' C411. <br />LOT /ST BLOCK 6 77 OF <br />fLA u 4- -�✓ j ,, C {% , v C— <br />JOB ADDRESS <br />J9,7 FrclrCaL �.2e e <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 />AIR COND UNITS—H P EA <br />BATHTUB <br />REFRIGERATION UNIT5—H P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS—H P EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />&0 <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />/ <br />LAUNDRY TRAY <br />UNIT HEATERS-8 T U M <br />/ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLE ADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC I <br />k <br />p <br />SUB TOTAL <br />(C960 <br />SUB TOTAL f <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />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 />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />IB DROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC <br />SEC 303(a) <br />2. BUILDING PLANS <br />TOTAL <br />2 <br />d <br />5 <br />FIRE HYDRANT <br />♦ FIRE PROTECTION SYSTEM <br />5 GRADING/EXCAVATION A CLEARINWGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />R. HEALTH DISTRICT - <br />AP iION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />T <br />9.1-79 <br />A <br />1 <br />J <br />04 <br />