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APPLICATION FOR <br />�1. <br />CiONSTRUCTION A <br />everett PERMIT <br />DEPT. OE COMMU141 EY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT,WA98201 []COMBINATION <br />24 '9 <br />BUILDING <br />❑MECHANICAL ❑PLUMBING PERMIT NO. <br />Zerect <br />e <br />ARCHITECT R DESIGNER MAIL ADDRESS <br />CITY ZIP PHONE LICENSE <br />CENMAL CONTRACTOR MAIL ADDRESS <br />27ozy <br />I.TY tlr PIIOnE LICE sf p <br />PLUMEIING CONTRACTOR MAIL ADDRESS CITY ZIP PIIONE lIC[NSFF <br />ON <br />CLASS OF WORK <br />PN W ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE JNSIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />$ Ifyy o� <br />DESCRIBE WORK <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOJEDUSFOF11 nowt <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />/�� SioaF <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />LEGAL DESCRIPTION OF PROPERTY )SHOWN BELOW OR ATTACHFOUR COPIES) <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT __ BLOCK —Of <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 />'/ <br />SIGNATURE OF RACTTORR CIR UTIIORIZFD AGENT DATE <br />IOH nDDNI SS <br />�/ <br />MECHANICAL <br />PLUMBING <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />UNITS-HPEA <br />WATER CLOSET ITOLIET).AIRCOND. <br />UNITS-ITP EA <br />BATHTUBREFRIGERATON <br />P. EA <br />LAVATORY (WASH BASIN)BOILERS-H <br />=FEE <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />SHOWERKITCHEN <br />AIR SYSTEMS-B.T U. M EA <br />SINK 8 DISP.FORCED <br />WALL HEATERS- B.T.U. M <br />DISWASHER <br />UNIT HEATERS-B.T.U. h1 <br />LAUNDRY TRAY <br />FVAPOR�\TINE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- CCht <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />- <br />ROOF F)RAINS -RAINLEAUERS <br />METAL I IREPLACE & CHIMNEI' <br />-� <br />SINK (SERVICE -BAR, ETC.) <br />C" <br />SUB TOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT <br />S <br />TOTAL F[[ <br />S <br />TOTAL <br />FIE <br />$ <br />FEE <br />RECEIPT NO. <br />SIDE YARD SETBACK <br />STREET Sf 113ACK <br />RD SETBACK <br />PUN CHECK NUMBER <br />PLAN CHECK <br />III <br />USE ZONE <br />LOT AREA <br />SITE <br />FEES <br />VALUATION <br />FEE <br />FVACANT <br />CINOTYPE <br />OF CONST. <br />OCCUPANCY GROUP <br />WELLING UNITS <br />BUILDINGSIZE <br />OF BLDG <br />NO. OF STORIES <br />C. LOAD <br />PLUMBING <br />BASEMENT <br />BEDROOMS <br />REQUIRED FIRE KLERS <br />MECHANICAL <br />❑YES ONCE <br />LZONE <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 <br />MINTAL CHECK LIST <br />PENALTY <br />LEB.C. <br />SEC. 303(a) <br />2. BUILDING PLANS <br />TOTAL <br />(9 <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />— _ <br />PERMIT VALIDATION <br />WHEN PROPERTY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />'rr�(�(fsj �(/Erc..i.(/F'✓ <br />5 GRADINGlE%UVATIONBCLEARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH D15TRICT <br />APPLICATION ACC. BY <br />�� <br />µ �R ISSUA�11 <br />//P <br />Le1`� <br />r <br />9-1 79 <br />