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TAB EPBFBYBPn APPLICATION FOR ���, <br />CITY OF CONSTRUCTION <br />everett PERMIT e <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 CITY ZIP PHONE <br />ZIP PHONE LICENSEE <br />-Y3 4 <br />PI LIMRI%G CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />CLASS Of WORK <br />NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />s )�,o no <br />(DESCRIBE WORK <br />PROPOSEDUSE OF BUlml%(; <br />/VsF <br />I HEREBY CERTIFY THAT 1 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 />X G. ?-q - 8 <br />LEGAL 06CRIPIION OF PROPERTY (SHOWN BlEON'OR ATTACH FOUR COPIE SI <br />p <br />Loll.S��p y BEOCxLy_OF� <br />JOB ADDRESS <br />3: C` P u L <br />PLUMBING <br />MECHAOICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSE I (TOUET) <br />AIR CONE) UNITS —HP FA <br />BATHTUB <br />REFRIGERATION UNITS—H P EA <br />LAVATORY (WASH BASIN) <br />HOILERS—H P EA <br />SHOWER <br />GAS FIRED AC UNITS—TONNACE EA <br />KITCHEN SINK IS DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS —BTU M <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- CFM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLE AM RS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE -HAR, ITC) <br />SUBTOTAL <br />SUB TOTAL F <br />PERMIT <br />F <br />PERMIT F <br />TOTAL FEE <br />S <br />TOTAL FEE F <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES CNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BE IIROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />nYFS ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />f DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />V BC <br />SIC 3034al <br />Z BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />5 GRADINGiEACAVATION S CLEARINCIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />J <br />9-1-79 <br />