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r <br />0 <br />L <br />6 <br />� <br />� <br />APPLICATION FOR ���,�„ <br />'"'E"'"'"° CONSTRUCTIO► : e <br />an ov <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICE$ . <br />CITY HA�L 259�8745 <br />EVERETT, WA98201 �COMBINATION � BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER M�II ADOX[55 CITY ZIP VHONE <br />� / :1 J./ i�.� r♦ . e- _ %% �Ovn� �fL"?�DI//9 <br />GENERAI [ONiN�[iOP M�IL �UORE55 CITY 21P PHONE IICFNSf I <br />M[CHAt�IUI CONiRAROR MAII AADPE55 CITY LIF PMONf IICENSF I <br />PIUmPI�vG CONTNACiOR M�IL �DORE55 CITY ZIP PHONE IICENSE 1 <br />❑NEW � �ADDITION ❑ALTERATION ❑REPAIR ❑DEMOL�TION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />W WAIION OF7R'OPK <br />���� O lg% <br />, �. <br />O(SCRIBE WORN <br />PNOPOSfD USF Uf BUIIDING <br />LEGAL DESCRIPiION Of VROPFRiY �SHOWN 9FlOW OR �TTACM FOUR COPIE5) <br />�o, z2 ewcK�_or �✓�r�y H;�/f D:✓ � <br />IOP�ODRf55 / <br />PLUMBING <br />NO. TYPE OF FI%TURE <br />WATER CLOSET ITOLIET) <br />gATHTUB <br />LAVATORY fW�SH BASIN� <br />SHOwER <br />KITCHEN SINK 8 DISP <br />DISwASHER <br />IAVNDRV TRAY <br />CLOTHES WASMfk <br />WATER HEATER <br />URINAL <br />DRINKINC FOUNTAIN <br />FLOOk DRAIN <br />VACUUM BREAKEH$ <br />SINK <br />USE ZONE <br />TYNE <br />IRE 20NE <br />-RAINIEADE0.5 <br />_P�O Rfl <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED 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 RECULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />$IGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />MECHANICAL <br />FEE NO. TYPE OF EQUIPMENT <br />AIR CONO UNITS—H P. EA <br />REFRIGER�710N UNITS—H.P. EA <br />BOLLFRS—HP.EA <br />GAS FIRED AC UNITS—TONNAGF EA <br />FORCED Alft SYSTEM$—B.T.U. M <br />WALLHEATERS—BT.U. M <br />UNITHFATERS-9TU. M <br />EVAPOR�TIVE COOLFRS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANCf HOOD <br />AIR HANDLINC UNIT— C F.M. <br />STOVE <br />METAL FIREPUCE 6 CMIMNEY <br />�f�M1T s <br />TO7ALfFE s <br />5T0.EET SETBACK R[Aft YAND SFTBA <br />LOT AkEA \'ACANT SITE <br />DYES ❑NO <br />OCCUPANCYG0.0UP NO.O�OWELLING <br />A��II0VAL5 <br />L FNVIRONMENTAL CHECK LIST <br />2. BUILDINL PIAN$ <br />) FIRE MYDNANT <br />1 FIRE PRO1fCTION SYSTEM <br />5 LRADINLIE%GVATIONBCLfARINC�CRUBflINL <br />6 DRAINAGE <br />7.fNVIRONMENTALIMPACTSTATEMENT <br />E. HEALTH DISTNICT <br />AVPLIUTION ACC. BY PUNS CHECKEO <br />47-79 <br />�r � DAiE <br />APPIt. FOR ISSUANCE BY <br />I�4i�� <br />SUt 70 <br />RlMIT <br />PLAN CHECK FEE <br />FEE I RFCEIPT NO. <br />BUILDINC — S <br />PLUMBING <br />MECHANIGL <br />OTHER <br />PENALTY UB.C. <br />SEC. 1011al <br />TOiAt <br />rElMIT VALIOATION <br />WHEN P0.0PERLV VALIDATEO (IN TMIS SPACF) iM15 IS VOUR PERMIf <br />� <br />� <br />J <br />� <br />