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the Enrymn APPLICATION FOR RYlPe„ <br />CITY OF �.JNSTRUCTION <br />everett PERMIT P+ <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2SM745 <br />EVERETT, WA 98201 COMBINA�TjI /O/N-- / El BUILDING �NG n❑V�MEE•CHANICA/L�/.t ❑:1 PLUMBING < PERMIT NO. <br />I' ^� <br />�R /9J lJ I�I.E)l./f�\L• I�•VNI L�/� CY�'LI t ZIP PHONE <br />ADDRESS GITY jl.'.•OE <br />ARCHITECT OR DESIGNIR MAIL ADDRESS • CITY ZIP PHONE <br />Je&-n/ Cgo C,s J ,rc N C ( 11') <br />MAIL <br />0 LQAf e/L <br />CITY <br />ZIP PHONE <br />PLUMBING CONTRACTOR MMl DDRESS CITY ZIP PHONE LICENSE I <br />pbVN1.e.IZ <br />❑NEW ADDITION ❑ALTERATION ❑RLPAIR ❑DEMOLITION 1❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF N'DBK <br />1 G hro*�O <br />DESCRIBE WORK <br />IfV'57Y91_L G✓OC)l� S, �U'2 <br />PROPOSED UST OF BUILDING <br />R-e C�C,477 it QGQ i-+�, <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 <br />;t ALL' y k" ? -£ R ,I"I <br />FECAL DESCRIPTION OF PROPERTY(SHOWN 011OW OR ATTACH FOUR COPIES) <br />LOT BLOZK_OF <br />IOIAIIO� SG �•QxZJ �Cw �(2c't� 9�, D3 <br />PLUMBING <br />MECHANICAL <br />N!fl <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />:ATLR CLOSET(TOLIETI <br />AIR COND UNITS -HP EA <br />:IATHTUB <br />REFRIGERATION UNITS -HP FA <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-B T U M EA <br />DISWASHER <br />WALL HEATERS-0 T U M <br />LAUNDRY'TRAY <br />UNIT HEATERS -BTU 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 F M <br />VACUUM BREAKERS <br />S1OVF(,-C- ,k <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC I <br />SUBTOTAL <br />SUN TOTAL S <br />PERMIT <br />S <br />PERMIT N <br />S <br />TOTAL FEE <br />S <br />TOTAL FEE IF <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />III. <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />3 <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES ONOC- <br />MECHANICAL <br />7 <br />rf <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />C B C <br />SEC JBRaI <br />3 BUILDING PLANS <br />TOTAL <br />sc <br />J FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />t GRAOINGIEACAVATION6Clf ARINGIGRUBIIING <br />N DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />R HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR It$UANCf BY <br />7 <br />9 1 79 <br />