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AP"LICATION FOR <br />the EYoprPRn CONSTRUCTIONCITY OF <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL DlPLUMBING PERMIT NO. <br />0 <br />PLUMBING CONTRACTOR 11ML ADDRESS CITY ZIP PHONE LICENSE F <br />CLASS OF WORK T-L'�iWY�I F�, 4"I l <br />91<'WW ❑LA��LDIT��IIIO��N �� All I RA�TIOO_N/ ❑REPAIR ❑DEMOLITION ❑FENIE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATIOttUH WORK _ X7) <br />S "z0/ (10U.� <br />DESCIIIET VVORkI,pL IAffilf/�'�vy/ <br />zaa• - - --- <br />Pao o,_s[D ;yG BUILDING _ <br />IIIICaIeVd✓ �GL'(eNAL�L� <br />- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LEAWS AN ORDNANCES GOVERNING THIS TYPE <br />O 1 D WTH WHETHER SPECIFIED HEREIN <br />OF WORK WILL BCI <br />OR NOT. THE GRA G F A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY O VI ATE OR CANCEL THE PROVISIONS OF <br />ANY OT R STA OR L CAL LAW REGULATING CONSTRUCTION <br />OR THE ERFOR NC OF CONSTRUCTION. <br />A <br />SIC ATUIT OF CON7R CT OR AUTHOI ZED AGENT DATE ANY <br />X <br />LFCAL OFSCR IPTN NOF PROPE RTY(SHOWN BELOW OR ATTACH IOUR COPII S) <br />LOT _B-OCK_OF -- <br />JOB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />T E OF EQUIPMENT <br />FEE <br />—:— <br />WATER CLOSETITOLIET) <br />D <br />AIR COND UNITS-H.P. EA <br />BATHTUB <br />_ <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY(WASH BASIN) <br />2 <br />(% <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED A UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISWA54ER <br />WALL HEATERS-B. T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS-BT U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <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 -RAINL EADF RS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE -BAR, ETC.I <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE, S <br />51DE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />SQS-67 <br />v <br />PIL <br />FEE ��� <br />�a a <br />CHECK FEE <br />RECEIPT NO. <br />S Qa <br />USE ZONE <br />— <br />FOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />HIP, <br />OCCUPANCY GROUP <br />5 Z <br />NO. OF DWELLING UNITS <br />BUILDING <br />pu <br />S �J <br />/ O 0 O G'" <br />3 3 <br />OO <br />SIZE OF BLDG. <br />NO. OF STORIES <br />1 W/ mc-zZ <br />MAX. OCC. LOAD <br />& 8 <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED �. <br />DYES O <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />L B f. <br />SEC 107(a) <br />2. BUILDING PLANS <br />TOTAL <br />> r <br />OQ <br />J FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION _ <br />V.HEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION&CLEARINGIORUBRING <br />6. JRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />