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r <br />APPLICATION FOR <br />'°.E"`°"'° ;,ONSTRUCTION `�e <br />cin oF <br />everett PE RM IT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259�8745 <br />EVERETT, WA9B201 �COMBINATION ❑ BUILDING ❑MECFIANICAL ❑PLUMBING PERMIT NO. <br />OWN[F MAllA0DN65 CITY ZIP PNONF <br />...� 1 / f _ _ . . . _ . � ._ / ! �f l l _ C7l9 7 /1 <br />�RCHrtFQORUViGNFR � M�IIADDREA ❑ir tir rnone <br />GFNEP�LCONi0.ACtOR M�Il�U0RF55 CITY � ZIP PHUNE UCENSF/ <br />� PIUMBI�vG CONT0.�QON MAII �DORF55 UIY ZIP PHONF IICFNSE 1 <br />CU55OF WORK b <br />. ❑NEW ❑AD�ITION ❑ALTERATION q�REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VAWAi1pNOf WORK <br />� 1�ti9.y�f <br />OIS�lH'nAK <br />Y <br />� <br />FRO�OSfD USF Of PUIIDING <br />Ze s n�,� 10. � <br />IEWI OFSCPIPiION Of P0.0P[(R/iY �51 <br />�p�IOCK,�(Of , <br />/ <br />a�r,�F �3 <br />IOP �DDRE55 <br />�C'/°/ Farlero <br />PIUMBING <br />NO. TYPE OF <br />WATEN CLOSET (TOLIE <br />BATHTUB <br />LAVATORYIWASM BAS <br />SNOWER <br />KITCMEN $INK 8 OISP <br />DISwASHER <br />IAUNDRYTRAY <br />CIOTHES WASHER <br />WATFR HEATEH <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />USF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />6ElOW 0R A1t�CN iOUR COPIF51 PROVISIONS OF LAW$ 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 />SIGNATUkE OF CONTRACTOR OR AUTHORIZED ACENT DATE / <br />. ��/ . 1� _� � ..�. /_� <br />AOOF DRAINS—RAINLEADERS <br />SINK (SFRVICF—BAR ETC 1 � <br />SUlTOiAI <br />HIIMIT f <br />TO7AlFEF f <br />Y�RD SEI2ACK STREFTSET9ACK RE <br />CONST <br />t0T AREA <br />B�SEMFNT I NkDROOMS <br />�n�ov�u <br />1. ENVIRONMFNTAICHfCKLIST <br />2. BUIL�ING PLAN$ <br />3 FIRE IiYDRANT <br />1. FlFE PNOTfCTIO.V SVSTEM <br />� 5 GNADINGf%GVAlIONBCLfARINGlGRUBBING <br />6 DR�iNAGE <br />7. ENVI0.0NMENTAL IMPAC7 STATEMENT <br />E. MEALTH DISTRICT <br />•vvi i[ATION ACC. BY PLANS CHECKEO <br />91-79 <br />VACANT SITE <br />❑YES ❑NO <br />�r <br />DATE <br />APPR. FOR ISSUANCE BY <br />MECHANICAL <br />OF <br />FFE <br />AIR COND. UNIT$—MP. EA <br />REfRIGERATION UNITS—H P. EA <br />BORERS—M.P. EA <br />CAS FIRFD A.0 UNITS—TONNAGE EA <br />fORCED AIR SYSTEMS—B.T.U. M EA <br />WALL HEATERS—B.T.U. M <br />UNIT MEATERS—B T U. M <br />EVAPORATIVE COOLERS <br />CIOTHES ORYERS <br />VENTILATION fAN <br />RANGFHOOD <br />AIR MANDLING UNIT— CF M. <br />STOVE <br />METAL FIREPLACE 8 iH�MNEY <br />SU� TOTAL f <br />►[lM1T f <br />TOiALiEE f <br />ifCK NU.NBFR PLAN CNECK FEE <br />iEE RECEIPT NO. <br />iEEi �ALUATION iFE <br />BUILDING f <br />PLUMBING <br />MECMANIGL <br />OTNER <br />PFNALTY UBC. <br />SEC. 70J(a) <br />TOTAI <br />RIIMIT VAUD�TION <br />WHEN PROPERIY VALIDATED �IN THIS SPACEI TNIS IS YOUR PFRMIT <br />� <br />�� _ ��_—. _. _ . _ _ _ � <br />� <br />��� <br />1 <br />� <br />