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the EwFpmEn <br />CITY OF <br />APPLICATION FOR <br />LONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 COMBINATION <br />DF <br />MAIL <br />❑ BUILDING ❑MECHANICAL <br />XPLUMBING PERMIT NO. <br />CITY ZIP <br />' 441-6(Da <br />MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />GENERAL CONTRACTOR <br />MECHANICAL CONi RACfOR <br />MAIL ADDRtSS CITY ZIP PHONE LICENSE E <br />PI <br />mbi <br />Ct ASS OF WORK p V <br />J❑ <br />NEW ❑ADDITION ❑ALTERATION ❑REPAIR DEMOLITION El FENCE ❑SIGN ❑GARAGE BUILDING REL•')CATION <br />VALUATION Of WORK <br />1 13 - <br />DESCRIBE WORK <br />PROPOSID USE OF BUILDIN] <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BILOW OR ATTACH FOUR COPIES) <br />LOI _ BLOCK — OI <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME 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 NOT THE GRANTING 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 OR AUTHORIZED AGENT DATE I ^ ^ <br />91 <br />ADDRESS <br />1` C <br />IOR <br />� <br />So �, Co CX WQL..Li V� <br />v 1' y '� u <br />A <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE FEE <br />AIR COND UNITS—H P EA <br />WATER CLOSET (10LIET1 <br />REFRIGERATION UNITS—H P. EA <br />BATHTUB <br />P LA <br />LAVATORY (WASH BASIN) <br />GAS FIRED AC UNITS—IONNAGE EA <br />GAS <br />SLOWER <br />FORCED AIR SYSTEMS —BTU M EA <br />KITCHEN SINK A DISP <br />WALL HEATERS —BTU M <br />DISN'ASHER <br />UNIT HIATERS—B T U M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />DRYERS <br />TIATION <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE A CHIMNEY <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR. ETC) <br />_ <br />L <br />Q <br />SUB TOTAL <br />Gv <br />SUB TOTAL <br />B <br />_ <br />1 <br />PERMIT B <br />PERMIT <br />S <br />TOTAL FFE Y <br />_ <br />TOTAL FEE <br />STRIET SETBACK REAR <br />B <br />YARD SETBACK <br />PLAN CHECK NUh1BCN PLAN CHECK FEE <br />S1DE YARD !FT LACK <br />FIE RECEIPT NO. <br />US[ ZONE <br />LOT AREA <br />VACANT S1TE <br />FEES <br />VALUATION <br />FEE <br />OYES CIND <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />I'LUMBING <br />FIRE ZONE <br />BASEMENI <br />[it DROOIS <br />FIRE SPRINKLERS <br />CNKLERSREQUI <br />MECHANICAL <br />7YES ONO <br />APPROVALS <br />By <br />DATE <br />OTHIR <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />EC JD;IAI <br />2 BUILDING PLANS <br />TOTAL <br />I FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN iM15 SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIIXCAVAI IONA CLI ARINGIGRUBBING <br />6 DRAINAGE <br />7. FNVIRONMEN1Al IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />