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r <br />1 <br />r <br />L <br />t- <br />TAB EargmR <br />CITY OF <br />APPLICATION FOR <br />e r Brett �ONPERMITTION <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 ZIP PHONE <br />�2EbO2l/ {C ITAI �A/KiA/S C705 ?4Ylt�cf 1 ItlE�� yQO7? L/$I-7i .J/ <br />ARCHIT(CTOR OESIG ER MAIL ADDRESS CITY ZIP PHONE <br />eve7etl <br />e <br />+owbodaf 'some AS IJ9,dode <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />SA�js AS �a[3oU>< — <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE # <br />SAmF - <br />PLUMBINGCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE# <br />SAME <br />CLASS Of WORK <br />❑NEW ❑ADDITION NALTERATION 5QREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK% O✓ <br />-->rer-rwrv—v V V <br />DESCRIBE WORK <br />Inc oA.eK Jr., f JCfiQAGr . mACJF CT-diA!2A.JAL/ . ICPNi1JI)C IAJALt Q4 C27i1Ai.S . J*9JA2i /BOOM <br />PROPOSED USE Of BUILDING <br />- TII/C <br />1 HE EBY CERTIFY THAT 1 HAVE READ AN 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 9/.261E <br />X In Lo rj E <br />LEGAL DESCRIPTION Of PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOi_Bloa 1't of _( n/7? <br />ALL <br />JOB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIETI <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 EA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISWASHER <br />WALL HEATERS-O.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CENT <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLEADE RS <br />METAL FIREPLACE B CHIMNEY <br />SINK (SERVICE -BAR, ETC I <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />$TOE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHICK NUMBER <br />PLAN <br />It[ <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 CLOST <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 />REDROOAIS <br />FIRE SPRINKLERS <br />P I KLERSREQUIR <br />❑V[S ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />URIC <br />SIC 303(a) <br />2 BUILDING PLANS <br />TOTAL <br />J FIR[ HYDRANT <br />A [IRE PROTECTION SYSTEM <br />5 GRADINGILXCAVATIONA CLEARINGGRUDRING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />01 <br />9.1-79 <br />L <br />