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APPLICATION FOP ee <br />the '°�°" CITY OZONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA9B201 ❑COMBINATION Cl BUILDING ❑MECHANICAL El PLUMBING PERMIT NO. <br />WHER (MIL ADDRESS CITY ZIP PHONE i <br />6ra r P G Pn tr v 510 Z 6aji D-E✓re 61_etel` I? Za3 ,j 5-3 -SSSZ <br />ARCHITECT OR DESIGNER T MAIL ADDRESS CITY ZIP PHONE <br />GENE)RJ(�LCONT0.ACTOR MAIL ADDRESS CITY ZIP PIIONI LICENSE <br />2 C DYRJI(i'orCE" /dlY� � <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY LIP PHONE LICENSE 1 <br />PLUMBING CONTRACIC," MAIL ADDRESS CITY LIP PHONE LICENSER <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALI I, RAT ION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑CARAGI ❑BUILDING RELOCATION <br />VALUAIION OF WORK <br />S <br />DI SCRIBE WOILK f ' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE OF BUILDING <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUPCOPIES) <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT BLOCK_._OF <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 />SIGNATUR F CONTRACTOR OR AUTHORIZED AGENT DATE <br />x ✓✓✓�����- <br />IOB Aooa[ss ' �� <br />f IL, G ��'�' l u <br />oz Ea s <br />MECHANICAL <br />PLUMBING <br />FEE <br />TYPE OF FIXTURE <br />FEE <br />NO. TYPE OF EQUIPMENT <br />NO. <br />. <br />AB CUNITS—HP EA <br />WATER CLOSET ITOLIETI <br />REFRIGERATION UNITS—M.PIA <br />BATHTUB <br />5—N.P. EA <br />LAVATORY (WASH BASIN( <br />GAS FRED AC. UNITS —TONNAGE EA <br />GAS FIRED <br />SHOWER <br />FORCED AIR SYSTEMS-0T U. M EA <br />KITCHEN SINK 6 DISP <br />WALL HEATERS—B.T.U. M <br />DISWASHER <br />UNIT HEATERS—NTU. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDING UNIT— C F M <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE oG <br />METAL FIREPLACE IS CHIMNEY <br />ROOF DRAINS—RAINLE ADERS <br />SINK (SERVICE —PAR, ETC I <br />SUB IDEAL S <br />SUBTOTAL <br />PERMIT S <br />PERMIT 3 <br />TOTAL <br />FEE <br />IF <br />FEE <br />STRLI T SLIBACK <br />IF <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK ILE <br />SIDE YARD SETBACK <br />ILL <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONCE <br />TYPE OF CONET. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />s <br />SIZE OF BLDO <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />FIRE ZONE <br />BASEMENT <br />BE OROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES ❑NO <br />APPROVALS <br />BY <br />DATE <br />pT0fAt <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />UBC <br />C ION.( <br />2 BUILDING PLANS <br />I FIRE HYDRANT <br />R FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />\VHEN PROPERLY VALIDATED(IN THIS SPACE171115 IS 1G�R PERMIT <br />S GRADINGILXCAVAIIONBCLEARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />91 79 <br />