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the Ewrpresn <br />CITY OF <br />ti.'PLICATION FOR <br />CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT.WA98201 WCOMBINATICIN <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />J^J OAW'NLVR JJ I 11(]nIW rC IU. 7l. \'L.Lll7-. I�CIV-+-I -ZS 1 -5773 <br />Y A 4- 1 <br />ZIP <br />CLE1NcR, <br />GENERAL CONTRACIOR MAR AODRFSS CIT, ZIP PHONE LICENSE <br />MICHANICAL CONTRACTOR MAIL AFITNESS (.I" ZIP PHONE LICENSE <br />Ni CONTRACTOR MAIL ADDRESS <n1 /IP PHONE LICENSE IT <br />0 ASS Or WORK <br />❑NEW ❑ADDITION �ALTERATIGN ❑REPAIR [:)DEMOLITION -]FENCE ❑SIGN ❑GARAGE ❑UUILDING RELOCATION <br />\ avnnnN or wo�MaAK�,w�l� <br />F �b'✓ Y <br />HIS(KIM WORK <br />DKEznJT sF i(o0c.Z -%-z) .DOLJFX 14PA9Tl46*� <br />PRoroSlDisr or xmti <br />I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS AP- <br />i�� �L fl0P/I -5M�-S <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />1 OI SCRIPIION OF PROPE RTY(SHOWN BELOW OR ATTACH FOUR <br />COPESI <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OIS o iF ocK 2- _OF �D'A%t\1 C <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE GR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAIN RECULATING CONSTRUCTION <br />OR THE PERFORMANCE OFF11I'''f{.,N'� ION. <br />SIGNATURE OF CONTRACTOR n{+UTM dlFIT DATE <br />/S Cam, <br />Tux +nnRl s+ <br />21 i to MLM (.1 < f C—N E�'cE"i-� <br />PLUMBING <br />MEC ANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIETI <br />AIR COND UNITS -HP EA <br />BATHTUB <br />El <br />REFRIGERATION UNITS -HP EA <br />1 <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />$HON'IR <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK & DISP <br />.�eI5yn� <br />CiAi <br />FORCED AIR SYSTEMS-B T U M EA <br />( <br />DIS\VASH[R <br />_ -_ <br />W ALL HEATERS-B T U M <br />LAUNDRYTRAY <br />UNIT HEATERS -BTU M <br />CLOTIOS \VASHIR <br />EVhPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />/ <br />STOVE <br />ROOf DRAINS - RAINLEADLRS <br />METAI FIRFPLACF &CHIMNEY <br />SINK (SERVICE -BAR. E ICE <br />SUB TOTAL <br />SUB TOTAL <br />PERMIT <br />F <br />PERMIT S <br />f <br />G <br />TOTALFEE <br />f <br />TOTALFEE <br />SIDE YARD SETBACK. <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />'35'USE <br />HE C3 <br />RECEIPT NO- <br />ZONE <br />--L <br />lOT A U <br />-7700 , cT. <br />VACANT SITE <br />OYES r1O <br />FEES <br />VALUATION <br />FFL <br />TYPF FC NST <br />OCCUPANCY CROUP <br />NO Of D_WWt I LING UNI15 <br />BUILDING <br />�p <br />S�/y.,/-r•i2'-- <br />L� <br />P 3 <br />SIZE OF BLDG <br />NO OF STORI[S <br />MAX OCC LOAD <br />Z <br />PLUMBING <br />(g <br />FIRE ZONE <br />BASEMENT <br />,E <br />Al <br />Ilk DROOS" <br />FIRE SPRINKLERS <br />REQUIRE <br />MECHANICAL <br />-� <br />j <br />CT Y'ES T O <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENAL TY <br />LLBC <br />SEC Tmta) <br />TOTAL <br />p <br />/) S <br />SI <br />: BUILDING PLANS <br />' <br />T FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED(IN THIS SPACE) THIS 15 YOUR PERMIT <br />_ y, a/, <br />/E, <br />_I4J• <br />5 GRADINC.II XCAVATION& CH ARINCIGRULTHINTJYAPPR <br />6 DRAINAGE <br />7 fNVIRONM[NTAL IMPACT STATEMENT <br />8 HFALTI( DISTRICT <br />APPLICATION ACC flY <br />PLAN$ CHECKE <br />TOR ISSUANCE BY <br />�r <br />�/ <br />E <br />7 <br />5 <br />