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fM EL+rprNn AIf LICATION FOR <br />CITY OF evere,CONSTRUCTION <br />T �i <br />DFPT OF COMML II'V DEVELOPMENTSERVICES PERMIT <br />CITY HALL 259.8'. <br />EVERETT. WA981:IT ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MMl A PRI .1 <br />���/- • [I flit/ <br />"'""'• "'•�"�^•^ <br />\ <br />�\ MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />GINS O IN ETOR <br />SII CNANIUI CONTMCIOR <br />MAIL ADDRESS <br />MAII ADDRESS <br />CITY <br />/0F7- <br />CITY <br />ZIP <br />LIP <br />PHONE <br />/ PHONE <br />/) LICENSEE <br />LICENSE 1 <br />PIUaflINI: CUNIRnCiOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSEE <br />NEW ❑ADDITION UALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE S!GN ❑GARAGE ❑BUILDING RELOCATION <br />N STION Of WORn <br />PR I'POSTD 1-4 GI III I I DI NC <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />I ACATION AND KNOW THE SAME TO BF TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINAACES 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 AU HORITY 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 />­775R <br />DGM OI SCRIPDON OI PROP)RTY ISHOWN RI ICA OR ATTACH FOUR LOPII SI <br />BIGLxOI <br />II H ♦DpNI <br />/ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />N'AIfR CLOSET (tOLIFI) <br />_ <br />AIR COND UNITS -HP EA <br />RATHIUP <br />REFRIGERATION UNITS-H P EA <br />1. AVAIORY (WASH BASIN) <br />BOILERS -HP EA <br />- <br />SHOWER <br />CAS FIRED AC.- UNITS -TONNAGE EA <br />iN <br />kliCH[N SINK &DISP <br />FORCED AIR iYST.MS-BTU MEA <br />OISWASMER <br />WALE HIMERS-B I M <br />"FEW <br />_ <br />IAUNDRY IRA) <br />UNIT HEATERS-B 7 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 />II COR DRAIN <br />AIR HANDLING UNIT— CFM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLEADE RS <br />METAL FIREPLACE & CHIMNEY <br />,INK (SERVICI -BAR, ITC) <br />SUBTOTAL <br />SUBTOTAL B <br />PERMIT EL <br />PERMIT B <br />TOTAL FEE S I <br />_ <br />TOTALFEE B <br />SIDE)1RDSITFIACK <br />STREET SRBAC" <br />REAR YARD SE THACB <br />PIAN CHECK NUMBER <br />PLAN <br />Fit <br />CHECK FEE <br />RECEIPT NO <br />USF ZONE <br />107 AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONS7 <br />OCCUPANCY GROUP <br />NO OP DWELIING UNITS <br />BUILDING <br />S <br />512[ OF BLOC <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBiNC <br />M[CHAN.;AL <br />FIRE 20N[ <br />BAS[ME NT <br />III DRI II)MS <br />FIRE SPRINKLERS <br />REQUIRED <br />"YES f'NO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTALCHECK LIST <br />Pf NAI. TY <br />UBC <br />SEC 303(a) <br />) BUHDING PLANS <br />) FIRE HYDRANT <br />TOTAL <br />J FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPLRLY VAI IDAT[D (IN THIS SPACE)'HIS 15 YOUR PERMIT <br />5 C RADINGII XCAVAI ION& CL I ARINGIGRUHHING <br />b DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKKEEDDflY <br />APPR FOR ISSUA E BY <br />9 1-79 <br />