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APPLICATION FOR Pe <br />CC ASTRUCTION <br />everett PERMI T <br />DEPT. Of COMMUNITYDEVELOPMENT SERVICES <br />CITY HALL 25941745 <br />EVERETT, WA 98M COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT N <br />❑Iv LDS ruua <br />OWNER MAII ADONf55 1 ?i37- %�Z <br />17n6Prfi M./)lSD 3y0e GnrP P)v E✓ere LCjf�2D✓ z <br />PIID!ul <br />LIP PNONI llt[NSFI <br />nv PHONE 51C[NSFG <br />CLASS Of WORK <br />❑NEW ❑ADDITION ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE []BUILDING RELOCATION <br />VALUATION Of WORK V <br />DOD <br />s ns <br />DLSCRIBF WORK �✓L r/MT �� <br />Ol' SPn at CYA CT 1 I I .L r _._.t, <br />e cYnay e/ I/G/o`er <br />PROPOsm Usi Of BWLDING r�N��PV <br />Will remau <br />l r7 <br />LECAL � z In <br />DESCRIPLIOti f, PROPIR1V 1511"NiNB� o O� TT�I'll 1 I <br />LOT BLOCKN;3 Of <br />JOB ADDRESS <br />PLUMBING <br />un I TYPE OF FIXTURE FEE <br />BASIN) <br />S <br />S <br />AREA <br />VACANT SI It <br />OYES )C„vo <br />Ell,OT <br />CONST <br />OCCUPANCY GROUP <br />NO. OF OWfI <br />:� <br />_ 3 <br />z- <br />iLDG <br />NO. OF STORIES <br />MAX. OCC. LC <br />'L <br />MAAPPRO%ALS <br />CV'I SI'ALS BV1. ENVIROI512. BUILDIN3FIRE HY4 FIRE PRO5 GRADINGLEARINGIGRUBIIINI;6. DRAINA <br />7. ENVIRONMENTAL IMPACT STATEMENT , <br />B. HEALTH DISTRICT <br />APPLICATION ACC. OY PL�SCHECKED BY APPR <br />P n <br />DATE <br />I_-•�-- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW TIIE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK 'NILL 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 />MECHANICAL <br />FEES <br />S <br />BY <br />W <br />EA <br />EA <br />FEE <br />TOTAL L <br />AIT S <br />AL FEE s <br />PLAN CHUCK FEE <br />1, E D O I RfuPT NO, <br />4V'?-. <br />SZ�Q•� <br />28 <br />)BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />UBC. <br />PENALTY <br />SEC 301ER) <br />TOTAL <br />PERMIT VALIDATION <br />SPACE) THIS IS YOUR <br />PERMIT <br />WHIN PROPERLY VALIDATED BIN THIS <br />91 79 <br />