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APFOIC4TION FOR + BYQfRIL <br />EM EFVnRn <br />GTY OF CONSTRUCTION ue everett PERMIT <br />DEPT. OF CON,:AUK TY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA482D1 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNED MAR ADDRESS <br />CPy ZIP <br />C .AVnN. 0I/�c ��U-'31 tq, a: <br />E J CC L%Ul\I cl�Zo CaCu.T S7 S �- C W/S II,' 6�;?/670 -?/U <br />CITY ZIP PHONE <br />>4Cr- C171' Loy 5f-4 L4- `7b/U snow <br />MECHANICAL CONTRACTOR MAIL AODR155 <br />CITY LIP PHONE LICENSE f <br />PHIMBING CONTRACTOR MAIL ADDRESS <br />TV ZIP <br />CIPHONE LICENSEE <br />F WORK <br />EW ❑ADDITION 011TERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />9 <br />Y'ALUATION(IF WORK <br />gsv <br />DIKBOB WORK <br />=EUTERk7XJ sf 7' 1_'U -/11=TT d✓/x7LL <br />P <br />rROPO9ED ELSE OF Riv)ING <br />LEGAL DESCRIPTION OF PROPERTY ISHOYAN BELOW OR ATTACH FOUR COPIES) <br />LOT __BLOCK -OF <br />B .DDRI SS <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />N'A1ER CLOSET TOE Ell <br />flAiM1VEl _ <br />IAVMORI' IWASH BASINI <br />SHOVER _ <br />K TIC HEN $INK A DISP <br />DISW'A9IF _ <br />LAUNDRY TRAY _ <br />CLOTHES WASHER <br />WATER HEATER _ <br />URINAL <br />DRINKING FOUNTAIN <br />I LOOK DRAIN <br />VACUUM BRIAKERS <br />ROOF DRAINS-RAINLEADERS <br />aNK ISFRS'ICI -OAR. I TC I <br />SIDE YAARD`M i^HAI <br />'//� <br />USE ZONE <br />—r <br />IYPE OF CONST <br />a- I w <br />SUB TOTAL __ <br />PERMIT S <br />TOTAL FEE S <br />RIFT SETBACK RE <br />LOT AREA <br />2 <br />FIRE ZONE BASEMENT IT DRDDMS <br />2 APPROVALS <br />FiAr <br />FEE <br />VACANT SITE <br />OYES GM0 <br />NO OF DWELLP", LINE <br />MAX OCC LOAD <br />FIRE SPRINKLERS <br />REQUIRED <br />ES E!NO <br />BY DATE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS A - <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNII+G THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE CRANTING 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 PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR CA AUTHORIZED AGENT DATE <br />1 ENVIRONMENTAL CHECK LIST <br />2 BUILDING PLANS <br />J FIRE HYDRANT <br />J FIRE PROTECTION SYSTEM <br />5 GRADINGIIXCAVATIONACtt ARINGICRUBBING <br />B DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC RY PLANS CHECKED BY APPR fOR ISSUANCE flY <br />NO. <br />AIR COND UNITS--H P EA <br />REFRIGtRATION UNITS --HP EA <br />BOILERS -HP EA <br />CAS FIRED AC UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS-E T U M EA <br />WALE ME AT[RS-BTU M <br />UNIT HEATERS-R T U M <br />VENTILATION FAN _ <br />RANGE HOOD <br />AIR HANDLING UNIT- C F <br />STOVE <br />METAL FIREPLACE A CHIMNEY <br />PERMIT f <br />TOTAL FEE R <br />PLAN CHECK NUMBER PLAN CF <br />7 ?:, FL�o2.m s R <br />FEES VALU ATIO`i <br />.V,5 / <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />UBC <br />PENALTY SEC 303(a)) <br />TOTAL I I [ ev-2 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />1-1 WM <br />9 1-79 <br />