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APPLOCATION FOR <br />CONSTRUCTION Pi <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-874S <br />EVERETT, WA9B201 ]COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />MAIL ADORE SS ZIP PHONE <br />OWNER <br />C����mtis �ew�� szo �Cpu�J�FN %���s�oh fe �1s^77ooz �13 z_z�4s��?�� <br />ARCMrt(CT OR D[UGNFR <br />MAILADORISS CITY ZIP <br />nA PHONF <br />Z1� �O11SC�\\kI: SAw� �C`dRe' <br />CENTRAL CON'k ACLOR_- MAIL ADDRESS CITY ZIP !NONE GC`.NSE/ <br />c- Co Poi x?sITGS ��� le WN) c181LS 3L o'yu ���� <br />j Alc�U �ar�l <br />PHONE <br />ALI (HAMUILON1RAC r05 MAIL <br />LA�I I�ADDRESS <br />V1CITY LIP IICENSf1 <br />a•V `2><- cJc,E I UCFNsiI <br />MAIL AOD SS CITY ZIP PHONE <br />ly l'NPNG ll: V10.ACfON _ I <br />CKyI ASS Of WORK <br />jKNEW ❑AUDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE DBUILDING RELOCATION <br />s uLAllnN rnwoRy <br />c9 <br />OEM RJR[ WORI, A. �A A C% 1 1 <br />t�l 2 UJ ;�toec s sal .•L \ <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />rRurj�sto ru of xwmwcr, <br />I <br />PLICATION <br />PROVISIONS <br />HEREBY <br />AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />uru DlscalPuoN of+ROPFR1r lsdowN xuoW OR ATTAoI rouR corns) <br />O <br />ORT PRESUME TO <br />NOTOF A PERMIT <br />O <br />Lol _ BLOCK of <br />AUTHORITYATOIV VIOLATE OR CANCELNG <br />THEPROVISIONS OF <br />THE <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />ANY OTHER <br />OR THE PERFORMANCE OF CONSTRUCTION, <br />S ,NATURE OF CONTRACTOR OR AUTHORIZED AGENI DATE <br />,//L <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />0 <br />AIR COND UNITS—H P FA <br />WATER CLOSET 1101IETI <br />REFRIGERATION UNI7S_H P EA <br />BATHTUB <br />OT <br />SJ <br />BOILERS —HP EA _ <br />I AVAIORY ;SA'ASH BASIN( <br />GAS FIRED AC UNITS— TONNAGE EA <br />SHOWER <br />f OHCED .AIR SYSTEM$ —BTV MIA - <br />KITCHEN SINK A D151' <br />WALL HF ATERS-0 T ll M _ <br />DISWASHI R <br />UNIT HEATERS —dTU M _ <br />LAUNDRY IRAs <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />O <br />T Hfs DRYERS <br />QFIVENTILATION <br />_( HEATER <br />FAN <br />d uA <br />URINAL <br />0 <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— C F M <br />FLOOR DRAIN <br />S70V[ <br />VACUUM BRIAKERS <br />MIIA[ I IRE PI ACC 6 CHIMNEY <br />ROOF DRAINS—RAINLkAUE RS <br />SINK(SERVICE —BAR [ICE <br />_ <br />SUB TOTAL S Ob <br />SUB TOTAL <br />PERMIT 3 <br />PERMIT <br />3 <br />']/ <br />% <br />TOTAL FEE S Q <br />TOTAL FEE <br />3 <br />PLAN CHECK FEE <br />PLAN CHECK N/UM/BERG/ F[E �zS� RECEIPT NO. <br />FEES VALUATION FEE <br />SIDE YAR�D�SE .ACK <br />STREET SETB ^ RE <br />AR YARDS (i BACK <br />USE ZONE <br />LOT AREA <br />VACA TI <br />/ <br />—!_ <br />C <br />BUILDING S�F.��.� �b7'L� C <br />TYPF -N 51- <br />I•VI <br />OCCUPANCY COUP NO <br />IFJ2 G. <br />Of DyEtAIIN=l11.1I5 <br />�� <br />SIZE OF BLDG <br />NO OF STORIES <br />AEACC LOAD <br />S <br />-- <br />q <br />---. <br />OL <br />PLUMBING <br />FIRE ZONE <br />BASEMENT HI DkO,,N <br />R�ESPNINKI IRS ARM <br />MECHANICAL <br />___. <br />CAL 11N0 <br />_ <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC 3030) <br />2 BUILDING PLANS <br />TOTAL <br />•— <br />3 FIFE HYDRANT <br />R f R' PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S GIaDINGII XC AVAI ION A CLEARINGIGRVBBINC <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALIH DISTRICI <br />APPLICATION ACC BY PLANS CHk CKED flV <br />APPR FOR ISSUANCE BY <br />li <br />9 1-79 <br />