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Pq <br />} <br />TM EwrynBn <br />A ^ P L I CATION FOR <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />e <br />DEPT OF COMMUNITY DEVELOPMENT <br />SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA98201 ❑COMBINATION ❑ BUILDING MECHANICAL ❑PLUMBING <br />PERMIT NO <br />OWNER <br />x T�AmEs <br />MAIL ADDRESS CITY ZIP <br />L-�, f <br />PHONE <br />,,c,O L &g*Lr R240----5 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE F <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR <br />AIL CRT CRE55 CITY ZIP <br />PHONE <br />X ��aYY cK. ry EY"Yms <br />(� <br />�c �0(I C I RL_ t� 1 L E.J EgEIT <br />PI LLMBING CONTRACTOR <br />MAIL ADDRESS CITY 21P <br />PHONE <br />LICENSE <br />CUSS OF WORK <br />>(NEW ❑ADDITION ❑ALTERATION ❑REPAIR []DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />f — <br />DESCRIBE WORK <br />LY�TA1 I I LYE•. IA VVAE\ �TTLIA <br />PROPOSED USE OF HOILDINC. <br />S I Ai C Lf- i 1L �S �CL�•� <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 ONTRAC OR R AUTHORIZED AGENT DATE <br />X 1 4- I l ->3a- <br />LEGAL DESCRIPTION OF PROPHRTY ISHO.N HOW oR ATTA01 FOUR cOPIlsI <br />LOT _BLOCK_OF <br />IOH AUURl S$ <br />r �lC l l?3a <br />PLUMBING <br />MECHA.NI A <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSE T (IOLIET) <br />4L. <br />AIR COND UNITS —HP EA <br />BATHTUB <br />a <br />p <br />REFRIGERATION UNITS—H.P EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED 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 I 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 []BEAKERS <br />STOVE <br />ROOF DRAINS — RAINLLADE RS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE —BAR. ETC I <br />? <br />SUB TOTAL <br />SUBTOTAL B <br />PERMIT <br />If <br />PERMIT 5 <br />TOTAL FEE <br />$ <br />TOTAL FEE B <br />SIDE YARD SETBACK <br />STEEL IT 511 BACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USF ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />f <br />SIZE OF BLDG <br />NO Of STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONL <br />BASEMENT <br />BI UROOMR <br />FIRE SPRINKLERS <br />REQUIRED <br />F)YIS FIND <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC <br />SIC 303(a) <br />2. BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />4 fIRF PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRAUINGI X(:.1VAIION 6 CL6ARINGIGRUBBING <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 I <br />I <br />9-1-79 <br />