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the EterproPn <br />CITY OF <br />APPLICATION FOP <br />CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />OR <br />MAIL <br />CITY ZIF' PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />N� <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY III' PHONE LICENSE IT <br />CLASS OF WORK <br />E NEW ❑ADDITION ❑ALTERATION Q�REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />$ �22 a915�'Te ann <br />DESCRIBE W9RK <br />PRoroA O" OI HUHpING <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 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 REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE G <br />�/D a <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN HLLOW OR ATTACH FOUR COME/ <br />LOT _FO BLOCK —Of <br />_ <br />JOB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET I16EIET) <br />AIRCOND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS—H. P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED A C UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS —EIS U. M EA <br />DISWASHER <br />WALL HEATERS—B T U M <br />LAUNDRY TRAY <br />UNIT HEATERS—B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C E 'd <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL fIRFPLACL A C IMNEN <br />SINK (SERVICE —BAR, LTC) <br />SUR TOTAL <br />SUB TOTAL f <br />PERMIT <br />f <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE LARD SETBACK <br />STREET SETBACK <br />REAR YARD SI TBA(K <br />PLAN CLICK NUMBER <br />PLAN <br />FEE <br />CHECK Fit <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />F[[ <br />TYPE OF CONST <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />1-1 UA181NG <br />FIR[ ZONE <br />IASEMENI <br />11E DROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />CYFS CNO <br />MECHANICAL <br />APPROVALS <br />11Y <br />DATE <br />OTHER <br />1 ENVIRONMINTALCHECKl1ST <br />PI MALTY <br />URIC <br />SEC 703(a) <br />2 BUILDING PUNS <br />TOTAL <br />T FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED DN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGA XLAVAIION A CLEARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPLE TOR ISSUANCE BY <br />9 1-79 <br />