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mE APPLICATION FOR <br />e,OF CONSTRUCTION <br />PERMIT e <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 25"745 <br />EVERETT. WA9R30T ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />C W'N MLA IJ��Al1.jUXI S/5 %/ /(✓t' per/ /�7'p'p <br />aV %^.¢/� U 1 T Cf / U � � PNfnF <br />U rL+ Zs7l <br />PI I'MRINC CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />❑NEWn ^^❑ADDITION <br />XAIL TION OF WORK <br />F <br />DISCRWTASOR{ - <br />7L. " Ytom. <br />ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION I <br />PROPOSHT L'SI OF BUILDING <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 PERFORMA E OF CONSTRUCTION. <br />SIC.NA I RE CO CT OR A ORIZED AGENT DATE <br />IEGM Of WRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT __BlocK__OF' <br />(IB <br />PLUMBING <br />MECHANICAL <br />_NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND UNITS-H P EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />I AVATORY (WASH BASIN; <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRFD AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-B T U 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- C F M <br />VACUUM BREAKERS <br />STnVE <br />ROOF DRAINS -RAINLEADE ITS <br />G 'REPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC I <br />SUB TOTAL <br />SUB TOTAL 5 <br />PERMIT f <br />PERMIT f <br />TOTAL FEE IF <br />TOTAL FEE f <br />SIDF YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE J <br />CHECK FEE <br />RECEIPT NO <br />0a 5 <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES CNO <br />1 <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />3 <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />i IRE ZONE <br />BASEMENT <br />III DROOAIS <br />FIRE SPRINKLERS <br />REQUIRED <br />F7YE5 ('NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC SFC 303(a) <br />7 BUILDING PLANS <br />7 FIRE HYDRANT�R <br />TOTAL <br />A FIRE PROTECTION SYSTEM APINIM <br />PEE- <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACEI THIS IS YOUR PERMIT <br />S GRADINGIF XCAVA'I ION A CLI ARINGIGRUBBING To <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT SENTIMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PI AN$ CHECKED BY APPEL FGR ISSUANCE BY <br />