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I <br />G <br />FAo EwrprSSn A P p L I CA T I O N FOR - RY�FL.IT <br />CITY OF C..�NSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT• INA 98201 ❑COMBINATION ❑ BUILDING NIMECHANICAL ❑PLUMBING PERMIT NO <br />Oyj /� 1 AOONI55 LIT\ ZIP PHONf G <br />/ '� P- ,T f"i!-%Z� ��S /L/!'/0/fO.y "°- _'LFxt, <br />ARCHITECT OR DESIGNER MAILADDRISS CITY ZIP PHONE <br />GFNEwM. CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY LIP PHONC IICFN$[ / <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE TIC"" E <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />\'AILLA{ION Of N'ORK <br />�C�OCJ <br />DESCRIBE WORK 1 , <br />�.(✓f%/ELL- P E%2 t1 <br />PROPOSED U51 Of BUIIOMC <br />Alfl T <br />I H_REBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOW THE S/.ME Tn PE 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 ONSTRUCTION. <br />SIGNATURE OF CONTRACT OR AUTHORIZEDAGENT DATE <br />x <br />LEGAL DESCRIPTION 01 PROPFRTYISHOM'N BELOW OR At{ACH FOUR COPIES- <br />LO{ BLOCK —OF �LA--i/✓/—' ,4-,`.U/�7—/a(`/E�l <br />� <br />hZ-47' rlfCA? t:-1/,2 i(1 L=2 s,C t t_D N <br />� / <br />l4+ 1/ 6� h(/fl PAMI:L�P-or QL:r pILQr rl�-fl(-�1,, �'j�- <br />Lox AuoalssLPriMr r•,T. ii l,K, neEtyry <br />r- zP E., , 5 <br />PLUMBIN <br />M ANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />''WATER CL05ET JOLIET) <br />AIR COND UNITS-H P EA <br />- <br />BATHTUB <br />REF0.IGERATION UNITS-H.P EA <br />LAVATORY (WASH BASIN) <br />AGILE RS-H P EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />I FORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL Hf ATERS--BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-0 T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M. <br />VACUUM BREAKERS _ <br />STOVE <br />ROOF DRAINS -RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC) <br />SUB TOTAL <br />SUN TOTAL S <br />PERMITS <br />PERMIT S <br />TOTAL FEE f <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDL. <br />NO OF STORIES <br />MAX OCC TOAD <br />PI UMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />YFS RNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />--� <br />7 BUILDING PLANS <br />PENALTY <br />U BC. <br />SEC. 3031A) <br />1 FIRE HYEIRA.NI <br />TOTAL <br />A FIRE IRO': [CTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />5 GRADINGIE%CAVAT ION A CLEAR INGIGRURBING <br />6. DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />APE <br />FOR ISSUANCE BY <br />