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r <br />y <br />It <br />APPLI'�.ATION FOP evereH <br />CIT 6eY OF .g,een �: O N S T R l� .1 C T 1 O N <br />CIT <br />everett PERMIT <br />DEP':. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVER:TT•WA98201 01COMBINATION El BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OW�r EJR / MAIL AUDRF55 Cl" ZIP PHONE S✓� _ 1C / <br />/ �.1/iz /V /A.. <br />CEN 0.Al CO TRACTOR <br />CITY <br />MAZE AD Rf55 CITY G% <br />PHON[ <br />LICENSE E <br />LICENSE <br />MECHANILAL CONTRACTOR <br />MAIL AVUHL55 CITY ZIP <br />s/f <br />PHONE <br />3orw,9y <br />IICENSE9 <br />Ay <br />__. ____ <br />..... .....e.a CITY ZIP <br />PHONE <br />LICENSE <br />PLUMBING <br />CgJL,,__A,,SS OF WORK <br />LNEA�W ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK lF <br />E r-'s7- s coo- 3caco FY c� sT ti 7aor/,'� �� BIJb <br />DESCRIBE WORK <br />tlt/ t.'Ai fin Bl( .JnO <br />PROPOSEDUSE OF BUILDING <br />/r <br />-'- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIO' AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />l�e <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPEIONOF PROPERTYISHOWN BELCWORATTACH <br />FOURCOPIES) <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />LOT _OF _ <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM-, TO <br />_BLOCK <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 />O� <br />�// <br />LAC// <br />SIG RE OFF/gONTRR/ACTO , R AUTHORIZED AGENT DATE iR <br />ADDRESS <br />JOB <br />YgY.vo-ly m.// -!_- ve <br />X ._—_...� <br />PLUMBING <br />MECHANICAL <br />FEEL -~ <br />NO. TYPE OF FIXTURE <br />FEE <br />NO. TYPE OF EQUIPMENT _ <br />WATER CLOSET (TOLIET) <br />Fx;l <br />AIR COND UNITS-H P EA <br />, <br />BATHTUB <br />REFRIGERATION UNITS-II.R EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA <br />_ <br />SHOWER <br />GAS FIRED A UNITS -TONNAGE EA <br />--- <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS -El 7 U M EA <br />DISWASHER <br />WALL HEATERS-B T.U. M <br />_I <br />LAUNDRY TRAY <br />UNIT HEATERS-B T U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />L'ET <br />URINAL <br />VENTILATION FAN <br />7 �' <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />ME TAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC) <br />SUB TOTAL <br />to <br />SUB TOTAL S <br />T <br />C <br />PERMIT <br />S <br />PERMIT S <br />S <br />Z <br />TOTAL FEE <br />S <br />TOTALTHE <br />SIDE YARD QFd BACK <br />STREET SCTB CK <br />RCAR YARD ETBACK <br />PLAN CHE K NUMBER <br />PLAN <br />FEE <br />�3_ <br />G/ECK F�LjEj wy <br />RE(DJ <br />/(% <br />'�� <br />/0 <br />b I/ <br />USE ZONE ' <br />0-1 <br />LOT ARE <br />VACANT SITE <br />❑YES QIQ6 <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONS <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />Sc2sae <br />�( <br />g / PillP52. <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX OCC. LOAD <br />40 5P� <br />PLUMBING <br />�y <br />FIRE ZONE <br />BASEMENT <br />BIOROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />REQUIRED /� <br />MECHANICAL <br />�7 <br />•� <br />E7YE5 O <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />_ <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />L liC <br />SIC )G3(a) <br />2. BUILDING PLANS <br />TOTAL <br />I <br />—"--- <br />J FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PLRMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIIXCAVATIONACLEARINGIGRUBBING <br />_- <br />6 DRAINAGE <br />_ <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT�� <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />i APPR�FOR IS(SUMaC_ By <br />9-1-79 <br />n <br />