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aLJNSTRUCTION <br />dre Evergnwen <br />everett PERMIT <br />DEPT, OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />HONE <br />MAIL ADDRESS CITY ZIP P <br />OWNER_ n - - - c> 'J'?-3s5-�%GO <br />everett <br />S <br />%of, /J'CO) , ­.-..n - - - - - ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY <br />: 7 LICENSE N <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHO <br />L i-T!G o <br />/J.COST /erne�. - - �t• /A eC <br />I00A&K 7722 1 <br />LIP PHUNC LICENSE N <br />F <br />MECHANICAL CONTRACTOR MAIL AGORFSS <br />CITY <br />B <br />CITY ZIP PHONE UCENSEN ER <br />PLUMBING CONTRACTOR MM EDDRESS <br />CLASS OF WORK <br />A41001.1"f ❑FENCE ❑S!GN ❑GARAGE L RUILDING RELOCATION <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />ION <br />VAWATION OF WORK <br />s <br />DESCRIBE WORK <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />FROPOSEL L Sr OF BUILDING <br />I HEREBY <br />KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PLICATION AND <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />L10LL ObIRIPTICN Of PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIESI <br />PROVISIONS <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />7A✓SoDi'P-/ <br />BLOCK <br />OK NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />OF <br />LOTS -OF _ <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR A THORIZED AGENT DATE <br />JOB ADDRESS <br />A <br />O L ✓L <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />FEE <br />AIR CONE) . UNIT$-H.P. FA <br />WATER CLOSET (TOLIET) <br />REFRIGERATION UNI FS-H.P. EA <br />BATHTUB <br />BOILERS-H.P. EA <br />I AVATORY (WASH BASIN) <br />CAS FIRED A . UNIT$ -TONNAGE EA <br />SHOWER <br />FORCED AIR SYST EA45-N.T.U. M EA <br />KITCHEN SINK & DISP' <br />WALL HEATER;-B.T.U. M <br />DISWASHFR <br />UNIT HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />.CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE IS CHIMNEY <br />ROOF DRAINS-RAINLEADER$ <br />_ <br />SINK (SERVICE -BAR. ETC.) <br />-; SUB TOTAL s <br />SUB TOTAL <br />PERMIT $ <br />PERMIT <br />s <br />q TOTAL FEE s <br />TOTAL FEE <br />s <br />REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />SIDE YARD SETBACK STREET SETBACK <br />FEE RECEIPT NO. <br />USE ZONE LOT AREA <br />VACANT SITE <br />FEES VALUATION r FEE <br />OYES ONO <br />. <br />TYPE OF CONST. OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING S <br />SIZE OF ❑LDG. NO. OF STORIES <br />MAX. OCC. LOAD <br />-+� r r <br />PLUMBING r <br />BASEMENT III DROOAIS <br />FIRE ZONE B <br />FIRE SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />OYES ONO <br />DATE OTHER <br />APPROVALS <br />BY <br />U 14 C. <br />T. ENVIRONMENTAL CHECK LIST <br />PENALTY $CC JUJ(al <br />2. BUILDING PLANS <br />TOTAL <br />T. FIRE HYDRANT <br />_ <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERM.T <br />5. GRAOINGICXCAVATION& CLI:ARINGIGRUBBWG <br />6, DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY AI'PR. FOR ISSUANCE NY <br />