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APPLICATION FOR �Y�P�n <br />^'MORrNn C0+4STR"UC*YI(JN. <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 d_..,, <br />EVERETT•WA98201 COMBINATION IfB'UILDING [[MECHANICAL ❑PLUMBING PERMIT NO. <br />ARCHITECT ORiDESIGNER MAIL <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP . PHONE LICENSE 4 <br />CLASS OF WORK ,,_,� <br />fl.TFnITInw RIANATION ❑REPAIR ❑DEMOLITION ❑FENCE BSIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />WORK <br />PROPYOSED1¢ _sT OF BUILDING <br />p e7TA� I )4 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE FRUE 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 AUTKORITY TO VIOLATE OR CANCEL THE PROVISIONS 01: <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X. <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BEl W OR ATTACH FOUR COPIES[ <br />_ <br />LOT BLOCK —OF <br />IOB ADDRESS <br />PLUMBING <br />MECHA [CAL <br />NO. <br />TYPE OF FI%i11RE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR CON) 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 A DISP <br />1 ORCED AIR SYSTEMS—B.T U M EA <br />DISWA5HER <br />WALL HEATERS—B T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />. <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F M. <br />VACUUM BREAKERS <br />S10VE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY _ <br />SINK (SERVICE —BAR. ETC) <br />sus 7oTAl <br />PERMIT <br />3 <br />SUBTOTAL S <br />PERMIT IF <br />_ <br />TOTAL FEE <br />S <br />TOTAL FEE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBLK <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO, <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE _ <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />1 <br />SIZE OF BLDG <br />FIRE ZONE <br />NO. OF STORIES <br />BASEMENT BEDROOMS <br />MAX OCC. LOAD <br />REQUIRED FIRE SPRINKLERS <br />OYES E1ND <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />UB C. <br />SEC <br />SEC. 307(a) <br />APPROVALS <br />BY <br />DATE <br />-- <br />I. ENVIRONMENTAL CHECK LIST <br />2. BUILDING PLANS <br />TOTAL <br />7 FIRE HYDRANT <br />_ <br />4 FIRE PROTECTION SYSTEM <br />— <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDAIED!!N THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION& CLLARINGIGRUBIII, <br />E. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />_— <br />B HEALTH DISTRICT <br />^ APPLICATION ACC <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />9.1.79 <br />