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the EvugrRRn APPLICATION F O R <br />CITYOF L JNSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT,WA98201 ❑COMBINATION ❑BUILDING El MECHANICAL ❑PLUMBING <br />PERMIT NO <br />OWNER <br />MAIL ADDRESS LL <br />CIIT ,I <br />/� 1r�ILL <br />•" <br />"'_"' <br />1 <br />- <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />..IP <br />PHONE LICENSE / <br />' <br />1 <br />MECHANICAL CONTRACTOR S <br />MAIL ADDRESS, CITY <br />R <br />rlLt'z jVjLbCov Sty . <br />Zip <br />l�roQ <br />PHONE LICENSE I <br />E) <br />%V-y2y3 kid SIN <br />�vr�y�� ;�„. <br />- <br />PLUMBING CONTRA TOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />rIG:L LICENSE/ <br />CLASS OF WORK <br />❑NEW ❑ADDITION <br />❑ALTERATION ❑REPAIR <br />❑DEMOLITION ❑FENCE IGN <br />❑GAVAGE ❑BUILDING RELOCATION <br />VALUATION Of NORK <br />s cj`�P J <br />S , <br />DESCRIBE WORKlE <br />PROPOSED USE OF BUILDING <br />I HEPEBY CERTIFY 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 PRESUM, TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS CF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUREOF CONTRACTOR OR AUTHORIZED ACENT DATE <br />x /—��� <br />UCALUESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT _BLOCK -Of <br />n <br />IOBADDRESSEL,,,,, * MA6- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEZ <br />WATER CLOSET (TOLIET) <br />AIR COND UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P EA <br />LAVATORY (WASH BASIN) <br />OILERS —HP EA <br />SHOWER <br />KITCHEN SINK 8 DISP <br />GAS FIRED AC UNITS —TONNAGE EA <br />GAS <br />FORCED AIR SYSTEMS — BTU M EA <br />DISWASHER <br />WALL HEATERS—B T.0 M <br />LAUNDRY TRAY <br />B T U M <br />UNIT HFATIVE <br />CLOTHES WASHER <br />C <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHESDRYERSFA <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— <br />VACUUM BREAKERS <br />STOVE <br />A1ETAl FIREPLACE 6 CHIMNEY <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR. ETC I <br />SUB TOTAL <br />PERMIT f <br />_ SUB TOTAL S <br />�— PERMIT B <br />_ <br />TOTAL FEE B <br />TO'AL FEE B <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <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 />S, <br />SIZE OF ULDG <br />NO OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />REQUIREFIRE D SPRINKLERS <br />OYES ONO <br />MECHANICAL <br />— <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U CC <br />SEC JOJIaI <br />2 BUILDING PLANS <br />TOTAL <br />7 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />l/,Y7jYt�n-0Af'C_- <br />i� <br />Q <br />I <br />— <br />5 GRADINGIIKCAVATION A CLEARINGIGRUBRING <br />6 DRAINAGE <br />". ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC. BY <br />NS HEC ED BY <br />r-,4 <br />o <br />/)PER, FOR ISSUANCE BY -, W, <br />9-1-79 <br />