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r <br />the Ewrgmn APPLICATION FOR evereH <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />r. DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9B2OT OCOMBINIATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER �+ MAIL ADDRESS CITY ZIP PHONE <br />1m:10ysc op 1 3{� r�/ s I �r> x "t 0 1 /gin h(� .?J 3 995-70 <br />ARCHITECT OR DESIGNER MAIL AD AI SS CITY / 71P PHDNL <br />P <br />PLUMBING CONTRACTO MAIL ADDRESS CITY ZIP PHONE LICENSE f <br />1t�t� <br />❑NEW ❑ADDITION NALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />DLSCRIBE WdIK <br />T,,,, --t^ m r <br />PROPOSED USE OI BUILDING <br />jr„-t- <br />I HEREBY CERTIFY THAT 1 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 PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERF RMANCE OF CONSTRUCTION. <br />SIGNATURE OF ONTRACTOR OR AUTHO IL AGENT GATE <br />y <br />LEGAL DISCRIP71ONOF PROPERTY [SHOWN BELOW OR ATTAC14 FOUR COPIES) <br />LOT _BLOCK_ OF _ <br />F <br />c <br />�^ ma�yy// // y/ �7 <br />G V rTC zj/7,yll so; G .pC <br />LOP ADD0.f 55 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIET) <br />AIR COND UNITS -HP EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />CAS FIRED A.0 UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-B.T U M EA <br />DISWASHER <br />WALL HEATERS-B T. U. AS <br />LAUNDRY TRAY <br />UNIT HEATERS-B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANCE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE -BAR. ETC 1 <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />5 <br />PERMIT f <br />TOTAL FEE <br />3 <br />TOTAL FEE IF <br />SIDE YARD SETBACK. <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />I!I <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 GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />5 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />CYFS ETNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />T. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />SI [' ....0 <br />2. BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION 3 CLEARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9.1-; 9 <br />