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APPLICATION FOR ��e <br />'"'E"'°'"" CONSTRUCTION <br />cin or <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259�87{5 <br />�EVERETT, WA9E201 (]�OMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBINC PERMIT NO. <br />� OWHEM j � MMl �DONf55 �7 CIiY ZIP PHONE <br />� � k.« � ��-u. � � 3� ..:�' �r O, � � 3 5 .s — �L �1 / / <br />z �- ['G� �`�O�- '� <br />�__ .� ..u� .nna�cc CITY 21P YHONE <br />_ GFNERAICONiR�C10R <br />MAII �OORE55 CIiY 21P PMOHE IICFNSE I <br />PWMPWGCONIP�CtOR MAIIA�DRE55 CITY ZIP PHONE . IICEN5E/ <br />CU55 Of M'ORK <br />❑NEW ❑ADDITION ❑ALTERATION �REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE BUILDING RELOCATION <br />VAW�iIOt+Of WORe <br />s ZoO, — <br />A <br />us[ or <br />LEWL �U�ESCpRIPiIOH Oi PROPENiY ISHOWN BElO�Y ON Ai1�CM fOUX [OPIF51 <br />ioi SJL_eioca__or Z� � l�%/Ll S D�✓ : <br />L^ 2 � [7 ��l�� sr._.�! <br />IOB �ODRESS <br />�1UM61NG <br />Np, TY►E OF FIXTURE <br />WATER CLOSET (TOLIET) <br />9ATHTUB <br />LAVATORYIWASH B�SIN) <br />SHOWER <br />KITCMEN SINK 6 DISP <br />DISW�SIIE0. <br />UUNORY 7R�Y <br />ROOF <br />VARO <br />OF <br />t, ETC 1 <br />SUtiOTAI <br />�f�M1T f <br />iOTAI FEF s <br />STRFET SETB/.CK REAR YARD 5 <br />LpT AREA VACANT SITE <br />OYES ❑NO <br />n[CUPANCYGROUP NO.OF DWEI <br />AM�OVAIf <br />L ENVIRONMENTAL CHECK LIST <br />2. BUILOING PlANS <br />I FIRF HYDRANT <br />♦ FIRE PROTfCTION SYSTEM <br />5 GRADINGE%GAVATIONBCLFARINGIGRU9AING <br />6. DRAIN�GE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />! HFALTH DISTRICT <br />APPLIUiION ACC. BY PIAN$ CHFIXED BY <br />9�1�79 <br />�� � DAiE <br />I HEREBV 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 GRANTINC 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 />SIGNATURE OF CONTRACTOR 1 UTHORIZED AGENT OATE <br />�� � 6 � <br />X !l�c��.f1i ' � <br />MECHANIC� <br />NO. TY�E OF EQUI�MENT FEE � <br />APPR. FOR ISSUANCE BY <br />REFRIGERATION Uni i>–n.r. cn <br />BOILERS–N.P. EA <br />GAS FIRED A.C. UNITS–T9NNnCE EA <br />FORC[D AIB SYSTEMS–B.T.U. M EA <br />WALL HEATERS–B1.U. H <br />unuTHFATERS—BTU. M <br />VENiILATION F�N <br />R�NGENOOD <br />AIR MANOIING UNIT— <br />6 <br />iEE f <br />CHECK NUMBER �` """" "' <br />FEF I RECEIPT NO. <br />BUILDINC I f <br />PWMNING <br />MFCHANICAL <br />pTHFR <br />U B.C. <br />PENAITY SEC. IOAaI <br />i07A1 I I <br />�f11MlT V�LIDAiION <br />WMEN P0.0PERLY VALI�ATED IIN THIS SPACfI TH�S IS YOUR PERMIT <br />