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r <br />EARS,„r,T„D APPLICATION FOP evereH <br />CITY OF CONSTRUCTION <br />everett PERMIT e <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES . <br />CITY HALL 259.8745 rbF <br />r EVERETT, WA9B201 ❑COMBINATION Ipl BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OW R MAU ADDRESS CITY 7IP PHONE <br />o�ee�ET. ill�urzt s//a/ 7e dmal ,>.u�11 s y�z�� a3�-�j�j' <br />ARCHITECT <br />��OR__DISIGNLR MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />PIUMBINLi CONTRACTOR MAIL ADDRESS CITY ZIP 'HONE LICENSE <br />CLASS OF WORK <br />❑NEW ADDITION ❑ALTERATION ❑REPAIR []DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VAIUAiIUN OI NURK <br />DISCRIBI WORT, -.I(� <br />,. e// ,p �[/ -yy�� // <br />a77 <br />PROPOME 51 1 0 DIN c-/ D <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 CONTRA TOR OR AUTHORIZED AGENT DATE <br />r <br />X y LJ j/ iz <br />UGAL gt`5CRIPIION OT PROPIRTYISHOWN RtwLY Dx aTAnt OUR COPE ) <br />LOT +7 FLOCK 7 OF , KQ iy.G�O� <br />OR ADDRI SS �E <br />J/ Cuecci�ilLcJA• i�Z�i <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 UNITS -HP EA <br />LAVATORY(WA>H BASIN) <br />BOILERS —HP EA -� <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK 6 DISP <br />FORCED AIR SYSTEMS—B T U. M EA <br />DISWASHER <br />WALL HEATERS —BTU. M <br />LAUNDRY TRAY <br />UNIT HEATERS—BT U M <br />W ASHE R <br />EVAPORATIVE COOLERSWELT" <br />WATER HTER <br />EA <br />I <br />I rinTY6c nxvc Rc <br />�nlnnKI <br />I <br />I 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 —RAINLEADE IRS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR, ETC I <br />RRMIT f <br />TOTAL FEE LEI I <br />SIDE YARD SFTBACK STREET SETBACK REAR YARD [TRACK <br />' <br />�' /o C1247 <br />USE zOyE <br />LOT AREA <br />I <br />C <br />ID ESNNo <br />TY OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />"Sr N <br />K3 ADDrria <br />% <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX. OCC LOAD <br />FIRE ZONE BASEMENT Nl UROC <br />IVD <br />APPROVALS <br />1. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />3 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 GRADINGIIXCAVATIONB CLEARINGIGRUBBING <br />b DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />N' 0h <br />RY <br />DATE <br />APPR FOR ISSUANCE BY <br />CHECK NUMBER <br />PERMIT f <br />TOTAL FEE f <br />PLAN CF <br />FEE 7 0 — I RI <br />FEE <br />BUILDING <br />SGr <br />mil/ <br />—T <br />L <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />UDC. <br />SEC. 303(a) <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />al <br />J <br />9.1 79 <br />