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Ins EPR;pI>Rn I ll ■" ■" L 0 C/ Y Y Y O N FOR <br />CITY OF ..OBSTRUCTION PV[Il11 <br />everett PERMITc <br />DEPT OF COAL•AUNITV DEVELOPMENT SERVICES <br />CITY HALL 259 0745 <br />(+ EVERETT•WA911201 []COMBINATION ❑ BUILDING ❑MECHANICAL PLUMBING PERMIT NO. <br />1 OWNTER „/T MAIL ADDRISS CITY ZIP PHONE <br />—.L+At�IC A--,-,OCIATFG --140 � FOerzter MALL-I�TAV 1 EST RF-7 Saco 1ss--5444 <br />ARCHITECT OR DISICHIR MAIL ADDRISS CITY ZIP PHONE <br />K) /A <br />GENERAL CON74AC TOR MAIL ADDRESS CITY ZII PNONL LICENSE <br />Tiraulc QsiCcT/}TES " (4Dz sE F%,—,y-'r E1,1AIA_L�cV I EJFi-F`FT 45'Lo4 c s444 <br />MECHANICAL CONTRACTOR AIAII ADDRISS C'' ZIP PHONE :IC(NS[F <br />N/A _ <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />_ NIA <br />CLASS OF WORK <br />❑NEW ❑ADDITION 9ALTERATION ❑REPAIR []DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VAT UA7ION Of WCUK <br />1 30b0.00 <br />DISCRIBT 1WORK 101,Y-AT P TPT'YA A>: f+r.rJ CTO I,-;,T'n lli ML? 'C:;n A INA CTS— AA A... <br />PROPOSE USL OI AUILDINc <br />4S.3G 0;7 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH15 <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 4E52a;�q� <br />X� OI-VYAES 3• t 20W1) <br />LEGAL DESCRIPTION Of FROM P TY(SHOWN BELOW OR ATTACH ;OUR COME 5) <br />LOT __ BLOCK OF <br />loB 4oZADDRus <br />5.1 , - <CF 9"AAL-L- A <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />WAliR CLOSET(TOLIET) <br />AIRCOND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION W115-1-1 P EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP [A <br />SHOWER <br />GAS FIRED AC UNITS—TONNAU[ EA <br />KITCHEN SINK 1. DISP <br />FORCED AIR SYSTEMS-8 T U M EA <br />DISWASHEP <br />WAL. HEATERS-8 T.0 M <br />!AUNSAY TRAY <br />UNIT HEATE RS—B.TU 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 />FLOUR DRAIN <br />AIR HANDLING UNIT—CFM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR, ETC) <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />f <br />PERMIT <br />TOTAL F[[ <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD 517BACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FE, RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />3 ��� _ <br />3(7 <br />S_U <br />SIZE OF BI OG <br />NO Of STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ONO <br />MECHANICAL <br />ArPROVALS <br />BY <br />DATE <br />OTHER <br />T ENVIRDNM[NTAL CHECK LIST <br />PENALTY <br />SEC <br />SEC ]O7 >i <br />2 BUILDING PLANS <br />1 FIRE HYDRANT <br />TOTAL <br />S� <br />r FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VAT IDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />S GRADINGR XCAS'AIION i CIA ARINGIGRUBP WG <br />------------------ <br />I DRAINAGE <br />T [NVIRONMENIAl IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />AFPR FOR ISSUANCE BY <br />,31 79 <br />