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APftICATION FOR <br />CANECONSTRUCTION <br />of an OF <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 � <br />EVERETT, WA 98201 COMBINATION � BUILDING ❑MECHANICAL DI LUMBING <br />;ND/W�NlR MAIL ADDRI S4 CITY ZIP <br />AADO JIJ• Z/i4E�,�/J /3/S [)&.r)�D� /L-IAR�yi//C 9B1g7o <br />ARCHITICIOROISIGNIR i MAILADDRISS CITY ZIP <br />1 <br />0 <br />PERMIT NO. <br />PHONE <br />&s3-a o V6 <br />GINIRAI h O 115 K MAIL ADDRISS / CITY } ZIP r <br />•Gd. ,,1 ( '9 9G//�S (�v S7 P U rl S K� !/ 1 tZEt Rln 3�`/1'i7�. �� SC E IT <br />lip�yy At(01]rl01 city lip <br />f PNON[ llf[NSEr <br />WI(11+hTI AI(ONIlFAC10R MAIL AD0Ril5 <br />%1111%I(OdIRACIOR MAIL.4OIIRI AS <br />I I All Of MIRK / <br />❑NEW ' ADDITION EALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARA E ❑BUILDING RELOCATION <br />S ALL'AHON Of WORK <br />S' 00a <br />DI SLRHII SAORK (��'./1F/"4 CN /^/G <br />_SAvFI<r,cock- Aam Shv� 2e <br />PROPOSED CW Of BUBDINC I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AI'• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />IICAL DI SCRIPUON Of PROP) RIY ISNON'N PIIOw OR ATTACH TOUR COPD SI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />'` i of /NTEIPC 17 ACV17-10 OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />101 'E FLOCK Or q OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />D 11/I51 0/0 '&w I 0-P Sllo • Cr- • WA5h;' j-kln ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />IoR +DOaI SS v ^ <br />lg <br />Ai <br />/ JO ' J/CU>•7C/w•-�-� <br />PLUMBING <br />is <br />- — _ _ — <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO.T <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIETI <br />AIR COND UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE CA <br />KITCHIN SINK R DISP <br />FORCED AIR SYSTEMS—RT U M EA <br />DISWASHIR <br />%VALE HEATERS —BTU M <br />LAUNDRY TRAY <br />M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />PRINKING FOUNTAIN <br />RANGE HOOD <br />—� <br />FIOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />SIOVt <br />_ <br />ROOF DRAINS— RAINIAAW ITS <br />METAL FIREPLACE N CHIMNEY <br />$INK (SERVICE —BAR. [ICE <br />SUN TOTAL <br />PERMIT <br />S <br />SUN TOTAL f <br />PERMIT S <br />-A <br />TOTAL FEE <br />S <br />TOTAL FEE { <br />SIDE YARD S[IBACK <br />STREET RTMCK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOi ARIA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />41ZE OF BLOC <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIR[ ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />F1YF5 C1N0 <br />MECHANICAL <br />APPROVALS <br />NY <br />DATE <br />OTHER <br />LIST <br />1 ENVIRONMENTAL CHECK U <br />PTY <br />PENALTY <br />UBC <br />If llU(al <br />_ <br />7 BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIE XCAVATION A CIE RINGIGRUBBING <br />6 DRAINAGE. <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />N HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9.1.79 <br />