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ACULICATION FOR everetl <br />NSTRUCTION e <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICE.`�, <br />CITY HALL 259-8745 <br />EVERETT, WA98201 000MBINATION ❑ BUILDING ❑MECHAN!CAL ❑PLUMBING PERMIT NO. <br />0ANER 7�MAIL ADUREss CITE ZIP PHONi <br />T � Y c /�s5o< 2 3 J ncov�c sT /�v%eL✓s�k N f D7�n/ %"i�D / - c % -/ 7a 7 <br />ARC:IITECT OR DESIGNER MAIL ADDRFSS CITY ZIP PHONE <br />CLVFRAI CONiq ACTOR MAII ADDR[SS CITY ZIP <br />�� �Pr LICENSE 1 <br />ON ISvDC-?-) //-le- 1-25 //LZ!/4✓e <br />(t::x r-61) a c}cr: MlIe <br />PLUMBING CON�T ^CTOR MAIL ADDRESS CITY ZIP P210NE LICENSE E <br />( E7;r ,) — <br />OO <br />ANEW OF LORK❑ADDITION (<ALT2RAT.ON ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDINGRELOCATION <br />VALUATION OF WORK � <br />II n 6e <br />DLSI RISE WORK <br />Air. <br />-RO^OSED <br />USE or BUBDIN. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAN.' �FO Bii TRUE AND CORRECT ALL <br />k/MCTCa f �a`�-ti - <br />PROVISIONS OF LAWS AND ORU,IN YNCE'_'GOVERNING THIS TYPO <br />LEGAL DESCRIPTION Of PROPl0.TY ISHOwN Y. LOW OR ATTACH FOUR <br />COPIES) <br />OF WORK WILL BE COMPLIED W I i H WHETHER SPECIFIED HEREIN <br />LOT _._._ <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />_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 />SIGNATURE OF CONTPAC [OR OR AUTHORIZED AGENT DATE <br />Ion AD INI ss <br />IfAl )%'—`z�/7 <br />X_.. � 2 y'� _ <br />PLUMBING <br />MECHANICAL <br />NO. <br />T•.'PE OF FIXTURE <br />FEE. <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET IIOLIFU <br />AIR COND. UNITS-H P EA <br />BATHTUB <br />REFRIGERATION UNITS-H.I'. EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H P. [A <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KI ]CHI'N SINK & DISP <br />IORCED AIR SYS7EMS-B.T.U. h1 EA <br />UIRVASHER <br />%VALE HEATERS -BTU. AE _ <br />LAUNDRY TRAY <br />UNIT HEATERS-BT. U. h1 <br />CLOTHES WASHER <br />I, <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS i <br />�1 <br />URINAL <br />DRINKING FOUNTAIN <br />_ <br />VENTILATION FAN <br />-_ <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />-_ <br />STOVE <br />- <br />ROOF DRAINS-RMNLEADE RS <br />METAL FIRLPLAC[ R CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />— <br />SUR TOTAL <br />SUBTOTAL S <br />-_ <br />T <br />PERMIT S <br />PERMIT <br />S <br />— TOTAL FEE <br />S <br />TOTALFEE $ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />III �,o <br />RECEIPT NO. <br />q 7-0 <br />/ <br />Z <br />7w / <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />OYES <br />FEES <br />VALUAT'OH <br />' <br />FEE <br />JUNO <br />jr-7YPPE OF CyOpNST. <br />N SI <br />OCCUPANCY GROUP <br />�fOD I-� <br />NO, OF DWELLING UNITS <br />-�yS�� <br />"In�KLERED <br />lI-Z <br />BUILDINGS��.ticl' <br />L <br />SIZE OF BLDG. (AFXrA) <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />' 75 7 5.F, <br />I <br />S9 <br />PLUMBING <br />FIRE ZONE <br />BASEMENT BI. DROOAIS <br />FIRE SPRINKLERS <br />REOUIRED (E505T•' <br />MECHANICAL <br />TTNb <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />- <br />PENALTY <br />U II C <br />2. BUILD:NG PLANS <br />_ <br />TOTAL <br />D. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />— <br />PERMIT VALIDA71ON <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) rlls . IR PERMIT <br />S. GRADING;EXCAVATION A CLEAR INI:IGRUBBING <br />A. DRAINAGE <br />7. ENVIRONMENTAI IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />_ <br />APPLICATION ACC I!Y <br />PLANS CHECKED 1 Y <br />nPIB FOR ISSUANCE Hs <br />J 1 <br />. ✓. A ' <br />G.l�. <br />"I s <br />