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DEPT, OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2SM745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING <br />❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />OWNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />T..,<.,.., /kosIr �oA.., 12�z <br />E�u.«r> <br />%87_03 <br />3S5_: Jco <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE E <br />Xgo4-r /%✓e/0,, <br />Go. i..r. <br />Oo. Bx J�aa <br />�r�+t�r <br />`13.203 -3Ss-1760 <br />, <br />CITY <br />LIP PHONE 'LICENSE 0 <br />.MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PLUMPING CONTRACTOR MAIL ADDRESS CITY Z. PHONE IICENSE <br />CLASS OF WORK ,,__,,,,�� <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR )®'DEMOLITION ❑FENCE ❑SIGN EICARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />WORK <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS .AP- <br />PLICATION AND KNOW T4E 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 STATI: OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR A THORIZED AGENT DATE <br />/PXS,- <br />LEGAL DESCRIPTION OF PROPERTY SHOWN BELOW OR ATTACH FOUR COPIES <br />.OT—/LBLOCK__OF <br />r <br />106 ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />'NATER CLOSET (TOLIEO <br />_ <br />AIR COND UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />BOILERS—H.P. EA <br />LAVATORY (WASH BASIN) <br />SHOWER <br />Ir <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK & D'SP. <br />FORCED AIR SYSTEMS-6 T.U. M EA <br />DISWASHER <br />WALL NEATENS—B.T.U. M <br />LAUNDRY FRAY <br />UNIT HEATERS—RTU M <br />CLOTHES WASHER <br />B� <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN1 <br />AIR HANDLING UNIT— CEM. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SFRVICE—BAR, ETC <br />SUBTOTAL <br />PERMIT <br />f <br />SUBTOTAL f <br />PERMIT f <br />70TAL FEE <br />f <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />USE ZONE <br />TYPE OE CONST. <br />STREET SETBACK <br />L01 AREA <br />REAR YARD SETBACK <br />VACANT SITE <br />DYES ❑NO 9 <br />PLAN CHECK NUMBER <br />FEES <br />PLAN <br />ELL <br />VALUATION <br />CHECK FEE <br />RECEIPT NO. <br />FEE <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG i <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE 77:FIRE <br />BA56ME NT <br />RI UROOALS <br />SPRINKLERS <br />REQUIRED <br />O?I.S DNO <br />MECHANICAL <br />k <br />I <br />APPROVALS <br />BY <br />DATE <br />OTHUZ <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303(a) <br />_ <br />2 BUILDING PLANS <br />TOTAL <br />3 FIRE 'iYDPAN1 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />\YI(1'N PROPS RLIVALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRA0IN(;JXCA%'ATION&CLEARINGIGRU8111NG <br />L. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED 111' <br />APPR. I.OR ISSUANCE BY <br />9-1 79 <br />