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APPLICATIO�V FOEt <br />`°.E°.`°`"° :O N ST R U CT I O f� c����n <br />cin ar � <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVE.OPMENT SERVICES <br />CITY HAIL 259�8745 <br />EVERETT, WA98101 (��dMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OwvFR h��IIeODNRS lilv ZIP PNON[ <br />Pic.n• niu.�( E�C1zrTi- Maw ��- <br />ARCHI�lCi OR �[SIGNf0. Mell AO�PfSS ❑IY ZIP VHOHE <br />OtSEN S�laNS �52 KP1�h'�17�' C.a✓✓�PBCw Ust-tF, 9�cs�8 <br />GINFRAI (ONIN�CI00. MAIt �OOMESS CI1T ZIP PHON[ IICINS[ � <br />CbM�gG—l-t. N�9N I120 F�r2�f�i,v -No. -S�--wsi 9$+D� 62373LFf ca•MP•�3i-zzzbq <br />�11C11emUl CONiRACiOR MAII AOpRRS UM1 bP PNON[ LIC(NS[ � <br />PIVMI11vLCOUIq�C100. melle00PE55 UfT ZIP PHON[ UC[NSEI <br />L�NEW ❑ADDITION <br />\'1� UAiIOti nf µORK <br />s Z�L10A0 <br />UISC4iq[ wORK <br />❑ALIERATION ❑REPAIR ❑DEMOLITION ❑FENCE �SICN ❑GA0.AGE ❑BUILDINC RELOCATION <br />ihry�ra, ox� 56ToF iwvM• <br />rxo�ln�or�i.-� 04' 7�i �T NbLL E�f`ltQ+i� <br />LLGL �6CRIFt�Ov Of VROPlRIY ISIIOKN 011OK OX �iIACH IpUR WPI(SI <br />lOi � OLOCN � Of <br />IOfl �OORISS _ � _ � <br />� �,�vz.?�r <br />PLUMBING <br />O. TYPE OF FIXTURE <br />K'ATER ClOSfT IiOliEll <br />pATNTUB <br />AVA70NY �WASM �ASIN� <br />5 �JWLR <br />KIT EN SINK 6 DISP <br />DIS\Y� HfR <br />UUNDH iRAY <br />ClU1HE5� SMFR <br />\VALER MEA7 <br />URINAI <br />ORINK�HG fOUNT N <br />fIOOR ORAIN <br />VACUUM 9NEAKfRS <br />ROOF �RAINS-NAINLEAD 5 <br />SINK �5[RVIC[-B�R, ETC I <br />SU! TOTAL <br />Y�F� 5[TDACK $iR[FT 5[TMCK <br />[OHE LOi ARFA <br />TYPE Of CONST <br />OF <br />ZOYE <br />GROUV <br />AP�IIOVALS <br />1 ENVIRONMENiAL CH[CK LIST <br />3 BUIL�ING PlANS <br />7 fIN[ MYDftANT <br />1 FINE VROTFCTION SYSTEM <br />5 GRAOINU!%UVATIONbCLfARINGIGRUBflING <br />6 ON��NAGE <br />]. ENVIRONMfNTAI IMPACTSTATEMENT <br />E HEMiII DISTNICT <br />APPUCAiION ACC BY PLANS CHfCNED BV <br />9 1 79 <br />VACANT SITE <br />OYES ❑NO <br />er <br />- rNsipE t�t.hw N slioP FhsuA, �j rnJ� <br />I HER[BY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP- <br />PLICATION AND KNOW THE SAMf TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLiED WITH WHETHER SPECIFIED HEREIN <br />OR NOi. THE GRANTING OF A PERMIT DO;S NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIQNS OF <br />ANY UTHER SiATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURf OF CONTRACiOR OR AUTHONIZED AGENT OAiE <br />X 'V n 77 <br />MECHANICAL <br />FFf NO. 7YPE OF fQU1PMEHT <br />A COND UNRS-H P. CA <br />RE IGENATION UNITS-HP EA <br />BOIL 5-NP EA <br />G�5 Fl 0 A C UNIT$-TONNACE FA <br />fONCEDA SYAEMS-OiU. MEA <br />WAIIHk�I 5-BT.0 M <br />UHIt H[ALERS OT U M <br />f\'�PONAIIVF C lERS <br />D�TE <br />PPN fON �SSUANCE BY <br />L . �- � <br />NANGIMOOD <br />AIN N�NDLW( <br />SiOVE <br />Mf TAL fBEPL. <br />- CiM <br />Y <br />PUN CH([g NUMdER PUN CHECK FEE <br />FfE I RECEIPT NO. <br />fEFS VAIWTION FI <br />WILDING <br />PIUMAING <br />MLCHANICAL <br />OTME0. <br />PEN�ITY <br />S <br />UBC. <br />$EC JOJ(a� <br />TOTAI I I <br />�[RMIi VALIDA71ON <br />WMEN PROV[NLY WLIDA7EDpN TMI S�TMI515 YOl/R PERMIT <br />� '� -� ��'C� � <br />