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FB. Ev/rpE/Br1 APPLICATION FOi�. <br />CIYOF CONSTRUCTION <br />everett PERMIT Ude <br />DEPT, OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA9B201 ❑COMBINATION ❑BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER qq p MAIL AOONf55 n CITY 21P PHONE <br />a6 elG 1 1 i ✓Y1 �/¢�/J/2� E �� L 98ot <br />' ARCHITECT DESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERAL CONMACTC: <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE UCENSF 1 <br />PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />CLASS OF WORK <br />❑REPAIR <br />EMOLITION ❑FENCE ❑SIGN <br />❑GARAGE ❑ BUILD INC RELOCATION <br />❑NEW ❑ADDITION <br />❑ALTERATION <br />VALUATION OF WORK <br />1 <br />DESCRIBE WORK' <br />PROPOSED USE OF BUILDING. <br />LEGAL C!ESSCCRRIPIION OF PROPERTY (SHOWN <br />FLOW OR AT ACH FOUR COPIES) <br />-^ <br />LOTBLOCK --OF <br />: <br />JOB ADDRESS v <br />I HEREBY CERTIFY THAT I HAVE READ AND LAAMIINLU Inu Ar- <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 AU/7/ 10RIZZEEEDD' AGENT DATE <br />//�/�/ <br />v Igo . i iz i / <br />PLUMBING Ir <br />MECHANICAL <br />FEE <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />NO. <br />AIR COND. UNITS-H.P. EA <br />WATER CLOSET (TOLIET) <br />REFRIGERATION UNITS-H.P. EA <br />BATHTUB <br />BOILERS-H.P. EA <br />LAVATORY (WASH BASIN) <br />CAS FIRED A . UNITS -TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />KITCHEN SINK A DISP. <br />WALL HEATERS-BT.U. M <br />DISWASHE0. <br />UNIT HEATERS-BT.U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />WATER HEATER <br />CLOTHES DRYERS <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />- <br />AIR HANDLING UNIT- C.F.M <br />FLOOR DRAIN. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEAMRS <br />METAL FIREPLACE 6 C.IIMNEY <br />SINK )SERVICE -BAR, LTC 1 <br />SUB TOTAL S <br />SUBTOTAL <br />PERMIT B <br />PERMIT S <br />TOTAL FEE B <br />TOTAL FEE B <br />SIDE YARD SETBACK STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />RECEIPT NO. <br />FEE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />E <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />REQUIRED FIRE INKLER5 <br />MECHANICAL <br />OYES ONO <br />APPROVALS <br />BP <br />DA71 <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B.C. <br />SEC. 303Ea) <br />2. BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />4, FIRE PROTECTION SYSTEM <br />ON <br />PERMIT PROPERLY <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />VA <br />5. GRADINGIEXCAVATION 6 CLEARINGIGRUSBING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLIE7T37 <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE RY <br />Jn <br />I <br />I <br />9.1-79 <br />