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meEwryreen APIOLICATION FOR • �YPPt„ <br />CITY OF CONSTRUCTION e <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />ARCHITECT OR DISICNE0. <br />MAIL ADDRESS CITY <br />GENERA NTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSEE <br />All CHANICAI CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE IF <br />I'LUMBINII CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE F <br />O ASS OF WORK <br />�NEW ❑ADDITION <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCES <br />---�- <br />IGN ❑GARAGE ❑BUILDING RELOCATION <br />%MUADn F WORK <br />err <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED LIST DI BUILDING <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />IIGNJ OI SCRIPT ION OF PROPS R TY(SHOWN BELOW OR ATTACH FOUR <br />COME SI <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />,OF —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 />G' �` <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />I <br />IOB ADD0.1ti <br />•? n <br />�X/ <br />X <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSLT (TOLIET) <br />AIR COKED UNITS —HP EA <br />REFRIGERATION UNITS —HP EA <br />BATHTUB <br />I AVATORY (WASH BASIN) <br />BOILERS —HP EA <br />GAS FIRED AC UNITS —TONNAGE EA <br />SHOWER <br />FORCEF AIR SYSTEMS -BTU M EA <br />KITCHEN SINK A DISP <br />WALL HEATERS-B T U M <br />DISWASHER <br />UNIT HEATERS-B M T U <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />SS'AFTR HEATER <br />CLOTHES DRYERS <br />FAN <br />a <br />URINAL <br />VENTILATION <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />�- <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS - RAINLEADI RS <br />METAI FIREPLACE A CHIMNEY <br />SINK (SERVICE -HAR_ ETC', <br />SUB TOTAL $ <br />SUBTOTAL <br />PERMIT S <br />PERMIT <br />S <br />TOTAL FEE S <br />TOTAL FEE <br />T <br />S <br />SIDE YARD SETBACK <br />57REf7 SETBACK <br />REAR YARD SETBACK <br />PLAN CH[CK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT .AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DYES ❑NO <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING, <br />FIRE ZONE <br />BASEMENT <br />HLOROOMS <br />FIRE SPRINKLERSREQUIR <br />MECHANICAL <br />CTYES FIND <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC IDJ(a) <br />SEC <br />TOTAL <br />2 BUILDING PLANS <br />J FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) TH151S YOUR PERMIT <br />5 GRADINGIIXCA\ATION A CLIARINGIGRUHHING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />911CKE BY <br />3APllFOR <br />��SSIJQNCE jLY <br />Lie Lt✓ru —� <br />l7 (� liD <br />91%9 <br />