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Ine EwroF..A APPLICATION FOR <br />CITY OF CJNSTRUCTION <br />everett PERMIT <br />DEPT, OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259 8745 <br />EVERETT. WA 9B201 F— COMBINATION ❑ BUILDING <br />MECHANICAL ❑PLUMBING PERMIT NO. <br />everetl <br />0 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE a <br />�1cw�Alan c,.\�r EVFerr <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />77nXI I az o o „4 11'? -7 I-Apr0,17VIJ9 Y <5Ef1'TJLE �l�L{-I100 <br />ZIP PHONE <br />CLASS OF WORK <br />MNFW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE 1351GN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK / <br />S A 7�i(J.00 <br />DESCRIBE <br />detyrox( ANDy�r:ST� �ATion1 b`E � <br />PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />S POp.TfAA . 00 S 0 PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION Of PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILL PE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />BLOCK OF 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 />I IUS ADDRESS <br />PLUMBING <br />.......... <br />.._ <br />FEE <br />NO. <br />TYPE OF EO"'PMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />AIR UNITS-M.P. EA <br />WATER CL05ET(TOLIETI <br />REFRIGf CER RATION UNITS-H.P. FA <br />BATHTUB <br />BOILERS-H.P. EA <br />LAVATORY (WASH BASIN) <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />SHOWER <br />FORCED AIR SY5T EMS-B.T U M EA <br />KITCHEN SINK d DISP <br />WALL HEATERS-B.T.0 M <br />DISWASHER <br />UNIT HEATERS -BTU. ATCLOTHIS <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />WASHER <br />VENTILATION FAN <br />1� <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT- CF Al <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />iTOVE <br />METAL FIREPLACE d CHIMNEY <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR. ETC) <br />_ <br />— <br />sue <br />PER; <br />TO7 <br />SIDE YARD SETBACK <br />STREET <br />USE ZONE <br />TYPE OF CONST <br />LOT All <br />OCCUF <br />SIZE OF BLDG. <br />NO OI <br />FIRE ZONE <br />BASIN <br />APPROVALS <br />1 ENVIRONMENTAL CHECK LIST <br />2 BUILDING PLANS <br />3 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRADINOIEXCAVATION d CLEARINGICRU8BING <br />6 DRAINAGE _ <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />e HEAL:H DISTRICT <br />REAR'IARD SETBACK <br />V .CANT SITE <br />OYES ❑NO <br />NO. OF DWELLING UNITS <br />eY I DATE <br />SUB TOTAL <br />PERMIT 1 <br />TOTAL FEE e <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />FEEs VALUATIONL FEE <br />BUILDING <br />S <br />PLUMBING <br />MECHANICAL <br />OG <br />OTHER <br />PENALTY <br />U B C. <br />SEC. BOB(a) <br />_ <br />TOTAL <br />PERMIT VALIDATIOI. <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />APFLIC ATION ACC BY PLANS CHECKED BY I APP0.. FOR <br />BY <br />