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L <br />ERR EvBgr"n <br />CITY OF <br />APPLICATION FOR <br />everett CnNPERMITTIOt v <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY F ALL 2SM745 <br />EVERETT, WA9B201 ❑COMBINATION <br />❑ BUILDING ❑MECHANICAL ❑PLIIMRING PFQMIT NO <br />evereB <br />e <br />,QENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE f <br />b uJYLQ- r— <br />MAIL <br />Lam <br />PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY 71P PHONE LICENSE f <br />❑NEW ❑ADDITION )fALTERATION ❑REPAIR ❑DEMOLITION ❑FENICE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK / <br />D65CRI BE 'ORKp/1 .� �pp n <br />IIn�I ll019JIrAA 14L 7nrn./L'/M o/A.N/En A 'v rY&b Al) <br />ry Ev <br />DPOSE D U51 OI BUILDING <br />7. �T <br />rZiiodol�- � <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 PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR .AUTHORIZED AGENT A- DATE <br />kl�� <br />LEGAL DESCRIPTION Of PROPERTY (SHOWN BILOW OR ATTACH FOUR COPIES) <br />LOT _BLOCK__OF <br />'IOB ADD I�i /1 <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 CONEY UNITS —HP EA <br />BATHTUB <br />REFRICE%ATION UNITS —HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />WALL HEATERS —BTU M <br />DISWASHER <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 />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />5-0 <br />SINK (SERVICE —BAR. ETC ) <br />SUBTOTAL <br />SUB TOTAL f <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBA77 <br />GEAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />ri YES LINO <br />FEES <br />VALUATION <br />FEE <br />TYPE Of CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UN117 <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO Of STURIE5 <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />111 DROUfaS <br />FIRL SPRINKLERS <br />REQUIRED <br />1YF5 [NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U BC. <br />SEC. 303(a) <br />BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADING,4 ACAVATION 6 CLf ARINGGRUtlHING <br />6 DRAINAGE <br />7 ENVIROH NENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC. BY C PLANS CHECKED BY <br />F <br />APPR. FOR ISSUANCE BY <br />J <br />9 1-79 bw <br />