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fAs Everyrsen A° P L 1 C A T I O N F O R everett <br />°""°F ..ONSTRUCTION e <br />evere�t� PERMIT <br />DEPT. OF CO.MMUNITY DEVELOPMfNT SERVICES <br />CITY HALL 159�8745 <br />EVERETT, WA98201 ��OMBINATION ❑ BUILDING ❑MECHANICAL ❑pLUMBING PERMIT NiD. <br />OWIrER M��l ADDN65 Clt\ ZIP PHONE <br />Taillia�n B. Stevens, 514 Olymnic Blvd, Everett, T9A 9R203 252-35�13 <br />AXClIIiICi OF OESICt�LR M�IL ADDRE55 ❑IV LP PHONE <br />Jerry t�1. I'ike 34i8 Wetrmre, L�erett, hT�, 9R2Q1 7,'_'2-05�{7. <br />G[N[FAL CONiRACLOR MAIL AUDRE55 ❑iY ZIP PNONE LICENSF I <br />None - Ownes will perform work <br />MFCM�I:IUI CONLR�CIOB MAIL �[�pNES$ pLY 11P PHON[ IICENSE I <br />N/A <br />�IU�IN\C IONiPACT00. MAII hDDftlSS ULY ZIG pNONF IICENSC I <br />N/A <br />ClAS� Of WOPK <br />❑NEW ❑ADDITION �ALTERATION ❑REPAIR ❑DBb10LITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOGTION <br />.nwnnou or woeK <br />s 7�000 <br />DlSCRItlf KOR6 <br />Rer,aval of waJ.l, modify restroans, add kitchen, and relocate bar <br />veorosEous� or nwiorrv•; I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />Tavern PLICATION AND KNOW TFiE SAME TO BE TRUE AND CORRECT ALL <br />i[eni oescairtioN or vaonarv �sHown o[iow ou nrrnn� roua mrnsi PRO\'ISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF'NORK WILL �E COMPLIED WITH WHETHER SPECIFIED HEREIN <br />ior niocK_or OR NOT. THF GRANTING OF A PERMIT DOE$ NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLA7E OR CANCEL THE PROVISIONS OF <br />��� A�I�. ANY OTH'eR STATE OR LOCAL LAW REGULATING CONSTRUCT�ON <br />OR THE PERFORMANCC OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE , , <br />IOH r.�00.65 <br />905-07 Madison, Et�erett <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />WATER CLOSET �TOLIET) <br />BATHTUB <br />UVATORY �WASH l7ASIN� <br />SMOwER <br />KITCMEN $W1:8 DISP <br />UUNDRY TRAY <br />WATER MEATER <br />UftINAL <br />FIOOR DRAIN <br />VACUUM pHFAKERS <br />ROOF DHAIM1S—RAINLEADERS <br />DE YARD SETOACI: <br />N ��j <br />iE ZONE <br />2_ v <br />TreE oc eor+s <br />�- !Hi <br />'S�I?ZF OF ULDG. <br />:.L�'�� S � <br />FlREZONE <br />PERMIT <br />TOT�L FEE <br />STRECT SCTM <br />w i� <br />LOT AHEA <br />OCCUPANCYI <br />F{ � <br />NO.OFSTOAI <br />� <br />6ASEMEI:T <br />APP�OVAlS <br />L EN1'IRONMENTAL CHECK LIST <br />i. BUII.DING YlANS <br />3 FIRE MYDHANi <br />�. FlFE PROT[CTION SYSTEM <br />5 GR.�DING/t%UVATIONBQEARINC/CRUBBING <br />6. DBAINACE <br />]. ENVIP.ONMENTAL IMI'ACT STATEMFNT <br />B. HEALTH DISTR:[T <br />APPUUTION ACl 01' PLAHS CMCCKED BY <br />� . c,c-� I � � <br />, <br />91-79 <br />FEE <br />1 <br />�S � <br />RUR YAft� SE7BAC <br />� <br />VACANT $ITb. <br />drEs �o <br />NO. OF DWELLING l <br />MAX OCC LOAD <br />� to � <br />FIRE SPRINKlERS <br />HEQUIRED� <br />❑YES I"fl0 <br />BT OAiE <br />APPft. FOft ISSUANCE BY <br />G. c-, <br />X ( l��"i:.,,; _ �� � , <br />MECHANICAL <br />NO. TYPE OF EQU <br />HEFRICERA710N UNITS—NP. EA <br />GAS FlRED AC. UNITS—TONNAGE EA <br />fOHCED AIR SVSTEMS-0 TL. h <br />IYALI Hf.ATERS—pS U. M <br />UNITHEAT[RS-13TU. M <br />EVAPORATIVE COOLEHS <br />Vf NTILATION FAN <br />RANGEHOOD <br />AIR HANOLING UNIT— CF.M. <br />STOVE <br />METAL FlNEPUCE & CHIMNEY <br />�Ol� ;.— /�L�F� <br />PUN �HCU: NUMfiER <br />BUILDING <br />PWMOING <br />MECHANIC�I <br />OiHER <br />PENAITV <br />SUB TOTAL <br />PfRM1T <br />FEE <br />'! C�. <br />U9C. <br />SEC 30Na) <br />� <br />t <br />S <br />CHECK FEE <br />RECEIPT NO. <br />:s81�o3 <br />FEE <br />� �� <br />TOTAL � I t'zA <br />PFRMIT VALIDATION <br />N'MEN PROPERLY VALIOATED UN iH15 SPACE� THIS IS YOUR CERMIT <br />_� <br />