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�� <br /> APPLICATION FOR ���,�„ <br /> ��TM�ro'"° ` 'CONSTRUCTIO(� � <br /> everett PERMIT e . <br /> DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br /> ❑TY HAtI 259�B745 <br /> EVERETT,WA 98201 �COMBINATION ❑ BUILDING ❑MECHANICAL � PLUMBING PERMiT NO. <br /> O NER MAII n00N65 CITY ZIP PHONf <br /> �i�cK A1. }�ENQY /Po-z �uu..P�acE �v�e�rr� g�zo3 ,.3-SS-3i�9 <br /> �R[MrtFCiOROF5IGMER MAILAOOP[SS CITY ZIP PHOHE <br /> GEMER�t[ON1RnClOR MAII AOONE55 CITY 21P PHONE IICENSE 1 <br /> A1FCM.1NIGl CONT0.ACTOR M�II nODN65 Ci1v LIP YNONF IICENSf 1 <br /> FlUM91NC CONiRAClOR MAII�D�R65 ���T ��P PHONE IICFNSE I <br /> ClASS Oi NORK ,�,/ <br /> ❑NEW ❑ADDITION LJALTERATION ❑REPAIR ❑DEMOLITION ❑fENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br /> VALUAIION Of NOY.R <br /> f <br /> 06CxIBE��ORK <br /> �EPCflC� lJ�q/nJ�l/F�rL�NES. .-�n�s'rr�cL /VEw BHnfRoom FIxN,P�5 � Kirck�.v S�NK <br /> YROVOSEDUSF OI BW101!vG I HEREBY CERTIF1' THAT I HAVE READ AND EXAMINED THIS AP- <br /> /�EivTi9L PLICATION AND KNON'THE SAME TO BE TRUE AND CORRECT ALL <br /> t[GAlD6CRiPiIOUOFPROVERiY�SMOWN9[lON'ONnTTeCNfOURCGFR51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK W�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> ior �eiocK_or OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION$ OF <br /> ANY OTHER $TATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CONTRACTOR OR AUTMORIZED AGENT DATC <br /> wn noon�ss �� <br /> /6 0 9 LomeAQ� x <br /> PWMBING M ANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOLIETI �� AIR COND UNITS—H P EA <br /> � B�TMTUB ✓ D REfRIGERA710N UNITS—NP.EA <br /> LAVATOftY�wA5HPA51N� I/ OU 901LER5—HP EA <br /> SHOwER ✓ GAS FIRfD AC UNITS—TONNAGE EA <br /> NITCHEN SINK 6 DISP FORCED AIR SVSTEMS—�T U. M EA <br /> �IS\vASMER WALIMEATERS—OTU M <br /> UUNDRV TRAY UNIT MFATENS—B i U M <br /> CLOiHES WASHFR EVnPORATNE COOLERS <br /> / WATER HFATEH ✓ O CLOTHES DNYFFS <br /> URINAL VENTIUTION FAN <br /> ORINNINGFOUNiAIN RANGf HOOC <br /> fLOOR ORAIN AIR HANOLINC UNIT— C F M. <br /> VACUUM 9REAKERS STOVE <br /> ROOF DRAINS—RAINLFADERS h1fTAL FIREPLACE b CMIMNEY <br /> $INK(SERVICE—BAR ETC 1 <br /> SUE TOTAI Q OO SU!TOTAL f <br /> PEIIMIT S Q�j �FIIMIT f <br /> TOTAL FEE f d TOTAL FEE f <br /> SIDF VANO SCTBACK STRf[T 5[TPACK RUR VARO SF70ACK PUN CMECK NUM9ER PLAN CHECK FEF <br /> FEE RECEIPT NO. <br /> USE ZONE LOi AREA VACANT SITE �FES VALUATION iEE <br /> ❑YES GNO <br /> iYPE OF CONST OCCUPANCY GROUP NO OF OWFLIING UNITS <br /> BNLDING 3 <br /> SIZEOf BLDG NO OF STORIES MA% OCC LOAD <br /> riu.Hninc d6 <br /> FlRE ZONF BASEMENT NLOHUOb1S REGUIRFIDNKI[RS MECNAYIUI <br /> rrrs r.No <br /> APPROVAlS 61 OATF OTNFR <br /> 1 ENVIRONMfNTALCHECKLIST pFNAITY UBC <br /> $EC JOI�a) <br /> 2 IlUIIUINC PUNS <br /> TOTAL <br /> ) fIRF NYDRANT <br /> � FIRf PFOTECTION SYSTEM �ERMIT VALID�TION <br /> 1VMEN PROPERLY VALIOATEDpN TMI$SFACEI THI515 YOUR PERMIT <br /> 5 GNADINGIf%U��110N8QfARINGIGRUBNING <br /> 6 DFAINACE <br /> 7 ENVIRONMFNTALIMPACTS7ATEMENT <br /> C MEALTH DISTRICT <br /> APPLIUTIOY ACC OY PUNS CHECKED 9Y �FPR iOR ISSUAMCk HY <br />