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APPLICATION FOR fYCTCL, <br />IT CCoASTRUCTION i <br />everett PERMIT <br />DEFT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 DCOMBIN.ATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN[// IAAII AOONESS CITY ZIP PHONE <br />ARCHITECT OR DLSIGN- MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRA[ OR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE LICENSE 4 <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION PEPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />S 4 /BOP/. <br />DESCRIBE /W/OOARK <br />9! , S <br />PROPOSED USE OF BUILDING <br />')A(c $ r <br />1 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 AGENT DATE <br />v <br />�WAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR[ PIES) <br />LOT �BLOGK_oF o/ <br />JOB ADDRESS _ / <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 (WASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNIT5-TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISWASHER <br />WALL HEATERS—B.T.U. AT <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOT14ES 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— CF M. <br />VACUUM BREAKERS <br />SIDYL <br />ROOF DRAINS— RAINLEADE RS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />$ <br />T07AL 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 />DYES ONCE <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING U7IT5 <br />BUILDING <br />S <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 />DYES ❑NO <br />MECHANICAL <br />•-- APFROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LI5T <br />PENALTY <br />U.BC. <br />SEC. lU31a) <br />:. BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />5. GRADINGIEXCAVATION & CLEARINGICRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IV THIS SPACE) THIS 15 YOUR PERMIT <br />6. DRAINAGE <br />7, ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9-1-79 <br />