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Th►EYBrgrBRn A P P U CATION FOR <br />CITY OF CGNSTRUCTION e <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT• WA 98201 ❑COMBINATION ❑BUILDING <br />❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />OW�JNER <br />mute Ge.17-6y <br />MAIL ADDRESS <br />57G2 Easf l�rE e_ <br />CITY <br />�prrl7% <br />ZIP <br />95203 <br />PHONE <br />353 -_5sS2 <br />ARCHITICT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />G[NERAICONTRACIOR MAIL ADDRESS <br />GCn/ny 57C2 Ore <br />CITY <br />ZIP <br />9$202 <br />PHONE LICENSER <br />X-/�ruce <br />Fuss <br />£�ere7l <br />353-.59S2 <br />MECHANICAL CONTR ACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />�E <br />❑NEW Id ADDITION <br />❑ALTERATION ❑REPAIR ❑DEMOLITION <br />❑FENCE <br />❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VAIUMION OF WORK <br />x R /, 00, L' <br />DESCRIBE WORK <br />Y /////J :A10 0A a <br />J d• JLECE II [/i•> �GG�ti <br />A <br />k <br />PROPOSED UST OF BU IEDING p <br />V ihnr'h d Lpr FnLI/ 100'1' s <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 RITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER OSTATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR Tilt PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />�— —�O _ O' I <br />X GCC'— ty�z iDs <br />LEGAL DESCRIPTION OF PRO^ERTY(SHOM'N BELOW OR/ATTACH FOUR COPIES) <br />Lot -BLOCK -Or /- BIOCK�Of 9JTOY+[A /gCre t <br />q 0 /c 2 l PS s So-11 �Q- /3 fc-P t <br />LOB ADDxtss <br />,5702 £asf �r.'ve <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLISTI <br />AIR COND UNITS-H.P. FA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED A . UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS-B T.0 M EA <br />DISWASHER <br />WALL HEATERS-B.T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS-B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HFAIER <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 />STOVE <br />ROOF DRAINS -RAINLE AIDE RS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICI-BAR. ETC I <br />SUB TOTAL <br />SUBTOTAL If <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />If <br />TOTAL <br />Fit IT <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES Qj�40 <br />' FEES <br />VALUATION <br />fit <br />T)P HST <br />—tit <br />OCCUPANCY GROUP <br />Iz-3 <br />NO. OF DWELLING UNITS <br />I <br />eunDlNc <br />s <br />SIZE OF BLEDG. Y b <br />i(zZr3 <br />NO. OF �TORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />DA51MLNT <br />L^./.�CJ. <br />BLDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />nYES L-140 <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U.B C. <br />SEC. IOHa) <br />2 BUILDING PLANS <br />TOTAL <br />J FIRE 14YDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 GRADINGIf%CA"ATIONB CLfA0.1NGIGRUBBtNG <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />V. c_ <br />APPR. FOR ISSUANCE BY <br />9.1.79 <br />