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EAP EvargrRan <br />CITY CF <br />AQ.QLICATION FOR <br />L JNSTRUCTION <br />eve.rett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA9820T ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS _✓C.ITTY- MA ZIP PHONE <br />Gw(% C4N-�- A(G.]�jfiot-t CkfLL,L ZV 4 EeYE.l e-u- <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY LIP PHONE LICENSE <br />/lrjzyps� S;q•t 5-n- (y�;L1ov $t� Seet7rlc R�1c+4 �J4 �(2y3 kf Rf <br />PHONE <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE IGN ❑GARAGE ❑BUILDING RELOCATION) <br />VALUATION OF WORK <br />S ,tirr?. G2_ <br />DESCRIBE WORK D"s. (L ::� C q .1 <br />PROPOSED USE OF BUILDING <br />I HEREBY CFATIFY THAT I HAVE READ AND EXAMINED THIS AP- <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 / <br />v p`^ �� <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT -BLOCK -OF <br />LOB ADDRESS ELeµ P-0 /E n, j, <br />` Lk.. �' /�'�(j(�_ <br />PLUMBING <br />MAECHANICALVV` <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIET) <br />AIR COND UNITS-H P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED A UNITS -TONNAGE EA <br />KITCHEN SINK b DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />D15WASHER <br />WALL HEATERS-B I M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />DRYERS <br />URINAL <br />_CLOTHES <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS - RAINLEADE ITS <br />METAL FIREPLACE IS CHIMNEY <br />SINK (SERVICE -BAR. ETC) <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT <br />3 <br />PERMIT 3 <br />TOTAL FEE <br />3 <br />TOTAL FEE 3 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />P( AN <br />FIE <br />CHECK FEE <br />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 />L <br />J <br />SIZE OF BLOC <br />NO. OF STORIES <br />MAX. OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />Bk DROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />E ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC. <br />SEC 303(a) <br />Z BUILDING PLANS <br />TOTAL <br />FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5 GRAUINGIf%CAVATION b CL[ARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS JSPACE) THIS IS YOUR PERMIT <br />/,C) <br />]E,^/� . {c p <br />,` �G'A d, L <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTR'CT <br />APPLICATION ACC. BY — P NS HECISED IS <br />r//ter <br />��Ij. `OR SUANCE BY <br />10 <br />