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LA,E"rgmn APPLICATION FOR �► �Y�,�„ <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 , � <br />EVERETT. WA9B2D1 COMBINATION 0 BUILDING ]MECHANICAL L7PLUMBING PERMIT NO. <br />OWNER MAIL ADDRIAS CITY ZIP PHONE <br />AA100 to 9B970 bs-3-a o sib <br />GINtRAt <br />{I?Y !L-IIfA L•� �j0 yls �a MAIL ADDRESS CITY ZIP PHONE LICENSE 1 <br />/ wR LV �6/r�- ),� S�e U P r] S ,NI 'Gee Zit o, -S( <br />\11111AnT( AI CONT1GCTOR MAIL ADDRESS CITY LIP PHONE LICENSE R <br />MAIL <br />Cl AS' Of WORK �,/ /Q <br />` ❑NEW ADDITION L"JAL TE RAT ION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARA E ❑BUILDING RELOCATION <br />SA11411ONOF WORK <br />1 5— 000 <br />0ISCR101 WORK <br />,5/fE£T/e0G/r_ /400 51Ld;;je / _l T /c <br />rROPos7D us1 of RunDINc <br />6 M— C JE/6 A/7L: J ,r!i.V 6 <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 <br />� ,� <br />X ' <br />IICA1 DISCRIP71ON Of PROPIRTYISHOW'N RLLOW OR ATTACH FOUR COPDSI <br />1013A Ll R\ocAOF qt OF /7L17ERi /71 ADDITkJ <br />�f 1/IS/ 0/J N0. / o-r Sno • Co • WaSh *tfl <br />1 <br />TUN +PORT SS <br />SO • <br />.�/ /PC7rr}iJ(Ec to/ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSLT(TOtHTj <br />AIRCOND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS—H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWS R <br />GAS FIRED A C UNITS —TONNAGE EA <br />KIICHI N SINK A DISP <br />fORCED AIR SYSTEMS-8 T U M EA <br />DISWASHIR <br />WALL HIATERS—BTU M <br />LAUNDRN 7RAN <br />UNIT HEATERS —BTU M <br />CLOTHISW'ASHIR <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />ORINFINC FOUNTAIN <br />RANGE HOOD <br />I LOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />S70\'E <br />ROOF DRAINS —RAINLE ADE RS <br />ME LAT. I )REPLACE A CHIMNEY <br />SINK (SERVICE —BAR. E IC) <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SCTBALK <br />REAR YARD SETBACK <br />PLAN CHECK NUMOER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES CHO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />III UNWMS <br />FIRE SPRINKLIRS <br />REQUIRED <br />nYFS ETNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC <br />SEC. 1011a1 <br />2 BUILDING PLANS <br />) FIRE HYDRANT <br />TOTAL <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGII X(_AVATION & CLF ARINGIGRUBIIING <br />6 DRAINAGE <br />7 ENVIRONM' NTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />