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f��Ewrpmn A�PPLICATION FOR_ <br />°'"°F a �ONST�UCTfON `"°"" <br />everett PERMIi e <br />DEP7. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL i59-8745 . <br />EVERETT, WA98201 �COMBINATION ❑ BUILDING GMECHANICAL <br />owHCR ❑PLUMBINC PERMIT NO. <br />M�IL ADpN65 CIiY ZIP <br />'f'. Ks2L�iL L�Cc�.v cr����"� 3� /��� y�,� PHo�E <br />�v Hir�cr ox n sic �e rl �� S lc� '„9�G1't...�J (.(J�� 9 J��{Srd % �� "vi ( 3 2 <br />C„ 1�L 1� ,� ."';�enoress , urr ,�, _..--- <br />_'-..._..�.�^ - mennooness � arr � <br />Z�P VHONF I.ICENSE 1 <br />MfCM�NIULCONIR�[tOR MAILADOqF55 <br />Clii LIP <br />YHOwE llC[NS[ 1 <br />�tUmPIUG CONiqACLON M,111 ApOft[SS <br />CIIY ZIV PNONF ❑CFHSE / <br />LLN)OlWpqK � <br />❑NEW ❑ADDITION ❑AITERATION ❑REPAIR <br />vnlUnllUNUf WONA <br />f <br />vxovost u us� ¢/ emiowc <br />lE LOFSCRIPil0Y01P0.0fFR1Y�SHOWNBlIOWORAIIACNfOURCOPlF51 <br />. Ol �_ PIOCK _� Of <br />109 AODR[SS � �y ,,yN� <br />(/-'-�/ / " /0 <br />PLUMBING <br />N�• TY►E Of FI%iURE <br />ROOf <br />USE ZONE <br />(WASH <br />SINK 6 <br />TRAY <br />AREA <br />NO OF <br />T9ACK <br />ARIIOVALS <br />1 E4VIRONMENTAL CNECK LI51 <br />2. 6UIlOING PUNS <br />7 fIRE HYDRANT <br />� fIRE PROTECTION $YSTEM <br />5 GHA�INC�f%CAVATIONBCLEARINGCRU9PING <br />6 ONAINACE <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />7. HEALTM DIST0.1fT <br />APPLIUTION ACC. BY PLANS CHEIXED 9Y <br />9�iJ9 <br />❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />� - F- �G 5 ��c-t� <br />I HEREBY CERTIFY THAT I HAVE READ ,1ND EXAMINED THIS A^- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDIN�NCES COVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PER�NIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOGL LAW REGULATINC• CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONT0.ACTOR OR AUTHORI2ED AGENT OATE <br />� J n � n <br />MECNANICAL <br />FEE NO. T OF EQUII <br />AIR COND UNITS—H.P. EA <br />REfRIGFqATION UNITS—M.P <br />BOILERS—HP. EA <br />GASFIREDAf UNiTS—TONI <br />FORCED AIR SYSTEM$—BSL <br />WALL HEATERS—B.i.0 <br />UNIT HEATE0.S—B.TL M <br />FVAPORATIVF COOLERS <br />_ CLOTHES ORYERS <br />VFNiILATION FAN <br />RANGEHOOD <br />AIR MANDI.INC UNIT— �J <br />$TOVE <br />MEiAL FBEPLACE 8 CHIMNEY <br />s su� ra <br />f ►ERMII <br />70TAL <br />RFAR Y�RD SE7BACK PLAN CHECK NUMBFR <br />FEE <br />VACANi SITF <br />❑YES ❑NO FFES � <br />�Y I DAtF <br />FOR <br />BY <br />CHECK FFF <br />RECEIPT NO. <br />{EF <br />BUIl01NG S `� <br />PLUMOINC <br />MEGMANIUL <br />OTMER <br />PfNALTY U.B.C. <br />SEC. JOl(a) <br />TOTAI <br />�EIIMIT VAIIDAiIOH <br />WHEN PRUPERLY VALIOATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />FEE <br />