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fMEwrprwn APPLICATION FOR <br />`m°F �ONPE M�TTION °"e <br />eveMett <br />DEPT. OF COM�. ''N�TY �EVELOPMENT SERVICES <br />CITY HALL 259-BA_ . <br />' EVERETT, WA 98701 �COM0INATION ❑ BUILDING ❑MECHANICAL ❑PLUMSING PERMIT NO. <br />� owNea ; Men.00aess <br />CIiY 21P PHONF <br />�� � l / - -.d ,�s c-=.. G z � :,7�' • �/"/ <br />�RfHITECTOR � FR/ � ��LGt�� �'�> C� 3_� .3 •- y-y �G <br />_ GFNFRAL[ONIR�CLOR M�II�OCRF55 �. <br />� CIiY Zip PNONE <br />LICENSE 1 <br />•••"••` LICFNS[ I <br />PIUMBING[pHTR�[TOR M�II�D�RE55 <br />���f Z�P PNONE <br />LICFNSF � <br />ClA55Of WORK <br />❑NEW CIADDITION ❑��TERATION �REPAIR L�DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VAtUAiIONOf WORK <br />� Z n0. <br />OFSCRyY[.yVOeA' � <br />�� 1 <br />VROVOSED USF Oi <br />IFL�I OFS[RIPTION Oi PROFFqTY ISNOWN BEIOW OR eiT�[H {OUR COPIE51 <br />io��BIOCN��Of ��.=✓ bii / D,✓ , <br />62 3� ��7�-��z�_�� <br />109 �DORE55 <br />rwMeiNc <br />Na• TY►E OF ft%iU�E <br />WATfR �LOSET�TOLIET� <br />BATHTUP <br />UVATORY (WASM BASIN) <br />SHOWER <br />KITCMEN $INK 8 DISP <br />DISWASHE0. <br />LAUNDRY TRAY <br />CIOTMFS WASHER <br />WATER HEATER <br />URIN�L <br />DRINKING FOUNT�IN <br />FLOOR DRAIN <br />VA('UUM BREAKFRS <br />ROOF ORAINS—RAINIEADERS <br />SINK�SFRVICE—BAR, ETCI <br />USF <br />TYPE OF <br />512f OF <br />STREfi SETOACK REAR YARD 5 <br />LOT AqFA y�CANT $ITE <br />❑YES �NO <br />DCCUPANCYGROUP NO.OFDWEti <br />AK�OVALS <br />1. ENVIRONMFNTAL CMfCK LIST <br />2 BUILDING PlANS <br />) FIRE HYORANT <br />1 FIRF PROTECTION SYSTEM <br />5 LRnDINC/f%CAVATIONBCLEARI.uGGRU9AING <br />6 DRAIN�CE <br />7 fNVIRONMENTALIMPACTSTAiEMENT <br />�Y <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 COVERNINC THIS TYPE <br />OF WORK WILL BE COMPLIEO WITH WHETNER 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 CONTRACTOR9R�UTHORIZED AGENT DATE <br />MECMANIGL ' '� � <br />FEE NO. TY►E OF EQUI�MENT <br />A�R COND UN175—HP. FA <br />REF0.ILERATION UNITS—H.P. EA <br />BOIlERS—HP. FA <br />CAS FIRED A.0 UNITS—TONNACE EA <br />FORCED AIR SYSTEMS—B T.U. M EA <br />WALL HEATERS—B.T.U. M <br />DAiF <br />BUIIDING <br />PLUMAING <br />MECMANICAL <br />OTHF0. <br />PENAITY <br />TOTAL <br />EATFRS—BTL. M <br />tATIVE COOLERS <br />5 ORYERS <br />1TION FAN <br />NOOD <br />JDLINC UNIT— �. <br />'IREPUCE 8 CHIMNF' <br />TAIiFF {� <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />VAlUAT10N iFE <br />f <br />U.B.C. <br />SEC. J03�a� <br />►EIIMIT VALIOATION � <br />WHFN PpOPERLV VAIIDATfD (IN TMIS SPACE� THIS IS VOUR PERMI'f <br />