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r <br />01 <br />L <br />RIB EvergrPon APPLICATION FOR everett <br />CITY OF CONSTRUCTION e <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES _ <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />' OWNER MAIL ADDRESS CITY PHONE <br />3o6 SE=. U_zv�, �i_t.wY cll 113 3-1-7-54P-4 <br />ARCH EfT OR DESIGNER MAIL ADDRESS CITY ZIP PHON[ <br />L <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />MECHANICAL CONTRACTOA MAIL ADDRESS CITY ZIP PHONE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LPCENSE0 <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WO K <br />T 1.) C <br />DESCRIBE WORK <br />US rz B-z To - <br />PROPOSEDUSE OF BUILDING n <br />TE,,, <br />I HEREBY CERTIFY THAT 1 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 <br />LEGAL DESCRIPTION OF PROPERTY (SHOM BELOW OR ATTACH FOUR COPIlW <br />LOT _ BLOCK —OF <br />)OB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND. UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK d DISP <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <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 />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />$ <br />PERMIT B <br />TOTAL FEE <br />IF <br />TOTALFEE R <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <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 />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />DYES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />T. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />UPC <br />SEC 101(a) <br />2 BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5 GRADINGIIXCAVATIONB CLEARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />E. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PL{NS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />9.1.79 <br />