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OGT F ,ONSTRUCTION 101jol <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 25"7/5 <br />EVERETT. WA98201 [-]COMBINATION El BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN �/ Mu'AIL A�76 /PHONE <br />a rQr <br />ARCHOf CT OR DESIGNIR MAIL ADDR' SS CITY ZIP PHONE <br />PI L'MBING I'ONTRACIOR MAIL ADDRISS CITY Z'i" PHONE LICENSE I <br />CI AA Of WORK <br />[]NEW ❑ADDITION ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />Y MUMIDN Of WORK <br />Y 4/,%a <br />❑ISCR f,J'R" A_/ _"01" Ylf-/ <br />PROPOSED OM OL BUIIITING <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 />SIGNATURE CO CT OR A FORIZfD AGENT, DATE <br />Z 4^�Y <br />1 <br />I IC.AI OI SC R ITT ION Of PROPERTY (SHOWN BELOW OR AI lACH FOUR COPY S) <br />- <br />LOT HIOCK_OI <br />1011 ADDRISS J' <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIFII <br />AIR COND UNITS —HP EA <br />BATHTUB <br />FEE RIGERATIONUNITS—HP FA <br />I AVATORY(WASH BASINI <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSIEMS—B T U M EA <br />DISWASHFR <br />If <br />If LL Hk ATERS-BIU M <br />LAUNDRY TRAY <br />HEATERS-PTV M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />IIRINAL <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 DRAIN5-RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK ISERVICE -BAR. FTC) <br />SUB TOTAL <br />E <br />N' <br />SUB T07AL B <br />PERMIT <br />S <br />7 <br />N <br />PERMIT If <br />TOTAL FEE <br />S <br />L <br />TOTAL FEE B <br />SIDE YARD SETBACK <br />STREET SETBACK <br />PEAR YARD SF TBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE E; 6 <br />CHECK FEE <br />RECEIPT NO <br />01 7 <br />USE ZONE <br />LOT AREA <br />VACANT S171 <br />,-]YES C-1NO <br />FEES <br />VALUATION <br />FEE <br />TYPE Of CONST <br />OCCUPANCY GROUP <br />NO Of DWI[[ INC, 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 />III DROOMS <br />FIRE SPRINKLERS <br />FIYIS FENO <br />AIE C/IANIC At <br />APPROVALS <br />BY <br />DATE <br />OTI(IR <br />1 ENVIRONMENTAL CHECK LIST <br />PINALTY <br />UBC <br />SEC )DAaI <br />Z BUILDING PLANS y <br />L <br />TOTAL <br />-EI <br />I FIRE HYDRANT <br />&L <br />A FIRE PROTECTION SYSTEM <br />E <br />PERMIT VALIDATION <br />WHEN PROPIRLY VALIDAIED (IN THIS SPACE( THIS 15 YOUR PERMIT <br />S GRADINCIF X(. AVAIION&(: L E ARING;GRUHHING <br />S DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPI (CATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE HY <br />9.1 9 <br />