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APPLICATION FOR ee <br />CTYOf ..ONSTRUCTION O <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT.WA98201 E]COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING VERMIT NO. <br />PHONE <br />OWNER <br />MML nDOMlsi CITr LIP <br />/i o�� ! // f SL1 �/ �3rcnc�w �Exm}� sy>lsv <br />pnA p PAS C A ZI Z PHONE <br />21P <br />NUMBING CONTRACTOR MAIL ADORNS CITY PHONI IIClNST1 <br />CLASS OF WORK ��..,,// <br />❑NENV ❑ADDITION ( ALTERATION ❑REPAIR ❑DIMOlI110N ❑IENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />D <br />f p <br />615CKIB WORK ( " <br />i <br />IIIJFe c. a Ine <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />rxoroslo USE of BUILDING <br />I HEREBY <br />AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />9s <br />PLICATION <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF PROPERTY [SHOWN BE LOW OR ATTACH LOUR <br />COPIfSI <br />PROVISIONS <br />WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />l[GAl OI SCRIPiION <br />OF WORK <br />GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT _BLOCK —OF <br />OR NOT. THE <br />OSTITY TO VIOLATE R PROVISIONS CANCEL THE <br />GIVE ANY OTHER ATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LOP ADDRL SS <br />• i� <br />3 S r• IAA'+ ; Uc re <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />FEE <br />AIR COND UNITS—H P EA <br />WATER CLOSET (101IE71 <br />R[FRIDERATION UNITS—H P. FA <br />BATHTUB <br />EA <br />---HP[A <br />LAVATORY (WASH BASINI <br />GAS FIRED AC UNITS —TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />KITCHEN SINK A DISP <br />W'All HATERS—B.T.U. M <br />DISWASHER <br />UNIT HLATE0.5—B.T U M <br />LAUNDRY TRAY <br />EVAPORATIVE COOlf0.5 <br />CLOTHES WASHER <br />CLOTHES DRYER% <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE 6 CHIMNEY <br />ROOF DRAINS—RAINLfAD[RS <br />SINK (SERVICE —BAR, ETC 1 <br />SUS TOTAL S <br />SUB TOTAL <br />PERMIT S <br />PERMIT <br />S <br />TOTAL FEE S <br />TOTALFEF <br />S <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />SIDE YARD SETBACK $TAFFY SETBACK <br />It C RECEIPT NO. <br />USE ZONE LOT AREA <br />VACANT SpI <br />fit$ VALUATION fit <br />DYES NO <br />==F <br />TYPE OF CONST. OCCUPANCY CROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE BASEMENT BLDROOMS <br />FIRE SPRINKLERSRtQU <br />MECHANICAL <br />DYES ONO <br />APPROVALS <br />BY DATE <br />OTHER <br />�-- <br />1. ENVIRONMENTAL CHECKLIST <br />UBC <br />PENALTY SEC. SORR) <br />2. BUILDING PLANS <br />TOTAL <br />2 FIRE HYDRANT <br />P0.0TECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE I THIS IS YOUR PERMIT <br />S GRADINGIEXCAVATION 6 CLEARINGIGRUBBING <br />B DRAINAGE <br />7, ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY BE. RED BY <br />APP SSUANCE BY <br />9.1-79 <br />