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AP�ICATION FOR everetl <br />C NSTRUCTION e' <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9R201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER [�� ✓� )VE . NdcOEAII ADDRESS CITY ZIP PHONE <br />I OI�W Gc KGv� T7 / "=rYTm t III ^)G srz;=e-?S �hT > Zc 98 r t r !o $77- <br />ARCHITECTORDESIGNER MAIL ADDRESS CITY ZIP PHONE <br />'06cj'"N 12. og-o Nb2n+ Nw7,-4 sr. 5P.>qI7-E /%iJ14, . g270/ -7/41 SIF7-03f3 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PRONE T0BIIC(Nj� i1 <br />ri/th/LvtSO corrSY co 33cz �FTw Sr rte�T 9�zer z�y-9(91 gfim�[Y <br />...ru.uvM rnuivAnnu MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CL.��ASS OF WORK <br />xNEW ❑.%DDI TION ❑ALTERATION ❑REPAIR ❑DLMOLITION ❑FENCE ❑51GN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Or WORK L ,'7(r,111,77 r <br />Aar'". <br />DESCRIBE WORK/"AT. STUD 6--j'P. &0 PbJ`Z77TbNs, MST• DECO ;p Ga)NFG• ft-+Z, M f�tUclWwOI^1SUC.- <br />f_ _ 111 01, I.IA.,;-C --, GP120A ] &LOB. <br />Ovcprinl'v. jw Fr 71 L...+ F I+41' <br />mToroMn usF OF nuuowc <br />%1,�7}YjL .S'2f2E (1-1415H 2 <br />I HEREBY CERTIFY THAT I HAVE READ AND 'iXAMINED THIS AP- <br />PLIC.ATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVSRNINC 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 F CONSTRUCTION, <br />SIGNATUR F CONTRACTO O AUTHORIZED AGENT DATE <br />I EGAL OFSCRIPTION OF PROFFITTY (SHOWN BELOW OR ATTACH FOUR COME 5) <br />LOT _BLOCK --CH <br />— <br />LOB ADDRESS / 4O S <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE. <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET JOLIET) <br />AIR COND. UNITS—H P. LA <br />BATHTUB <br />REFRIGERATION UNITS—H. P. LA <br />LAVATORY (WASH RASINI <br />ROLLERS—H P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK E. DISP. <br />FORCED AIR SYSTEMS—B T.U. M EA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEAFERS—B.T.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 />FLOOR DRAIN <br />AIR HANDLING UNIT— CF AT <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR. ETC.1 <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />5 <br />TOTAL FEE S <br />SIDE YARD TTBACK <br />Ak <br />STREET SETBA K <br />7 /5 <br />/J <br />REAR YARD S /T�BACK <br />(- <br />PLAN CHECK NUMBER <br />O ` '/ <br />(/FEES <br />PLAN <br />FIF//&B.40 <br />CHECK FEE <br />RECFIPi7. <br />USE ZONE <br />G-I <br />LOT AREA <br />VACANT SITE <br />DYES ql�NO <br />VALUATION <br />FEE <br />TYY}PEFE.. OF CON�STL <br />'m— I �—E p— <br />OCCUPANCY CROUP <br />t7— 7- <br />NO. OF DWELLING UNITS <br />BUILDING <br />`�1111n100C1d <br />�l <br />Ci <br />SIZE OF BLDG. <br />NO. OF IES <br />ISJ-OR <br />MAX. OCC. LOAD <br />2`14 4 <br />PLUMBING <br />FIRE ZONE <br />2 <br />BASEMENT <br />n/O <br />F13EDROOMS <br />FIRE SPRINKLERSREQUIR <br />DYES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UA.C. <br />SEC. 303(a) <br />2. BUILDING PLANS <br />TOTAL <br />]. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5. GRADINGIEXCAVATION & CLEARINGIGRUBBING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />awM <br />APPR. FOR ISSUANCE BY <br />9-1-79 <br />