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the L'ver�reer! A P P.W C AT I O N FOR " everett <br />L.I,Y�F CCASTRUCTION e <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2598745 <br />EVERETT, WA98201 []COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />nwuco uui mneccc rOv 71P PHONE <br />GENERAL CONTRA OR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE R <br />V <br />_ <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSEE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP rHONE <br />LICENSE E <br />❑NEW ❑ADDITION ❑ALTERATION F—AEPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />s in ni+i v u <br />DESCRIBE SVORK n <br />d!r- 1r1 A C4 CG <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <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 AUTHORIZED AGEN,T/. DATES <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR /ATTACH FOUR SgPPIES) <br />LOT CBLOCK_OF Wa �J-c/9 a/ <br />,L✓J/ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND. UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS —H.P. EA <br />LAVATORY OVASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS=TONNAGE EA <br />KITCHEN SINK S, DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.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 />_ <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 />_ <br />SINK (SERVICE —BAR. ETC.I <br />SUBTOTAL <br />SUBTOTAL $ <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK. NUMBER <br />PLAN <br />flk <br />CHECK FEE <br />RECEIPT NO. <br />USE LONE <br />LOT AREA <br />VACANT 5ITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONRT. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ONO <br />MECHANICAL <br />_ <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />llH C <br />SIC IOJfaI <br />2. BUILDING PLANS <br />TOTAL <br />). FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />S. GRADINGIEXCAVATION G CLEARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPFRLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPR. FOR ISSUANLk BY <br />