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APPLICATION FOR PY <br />el" OF ; ONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS It 77 ITO-.9 CU•-i1Y ZIP PHONE <br />I u • -vo. "6F i a , iFXo� Lo 5V1 77 <br />.ARCHITECT OR DESICNER <br />1 1.JO .• - _� `mil 0 3 <br />O"�E(��/'/�'E/�AI CONTRACTOR <br />^ <br />I <br />/ <br />M/�Il A0DRE551 <br />CITY <br />C. <br />ZIP <br />-J <br />PHONE :4 ENSEI <br />�city <br />ZIP <br />PHONE LICENSE <br />MECH NCA1 CONTRA TOR <br />MAIL ADDRE55 <br />j <br />CITY <br />ZIP <br />PHONE LICENSE <br />1 ' PIUMBING CONIRAQOR <br />MAIL ADDRESS <br />❑NEW ❑ADDITION ❑ALTERATION NREPAIR <br />VALUATION OF WORK e)CE <br />53,�Coo — <br />SCRIBE WORK <br />�/iNVEYJ.� y <br />P POSED US IOF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BFLO OR ATTACH TOUR COPIES) <br />LOB ADDRESS <br />?LUMBING <br />OF <br />SHOWER <br />KITCHEN SINK A <br />DISWASHFR <br />LAUNDRY TRAY <br />CLOTh ES WASH <br />FOUNTAIN <br />ROOF D <br />SINK (Si <br />ETC 1 <br />❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />FEE <br />TOTAL FEE <br />SIDE YARD SETBACK STREET SETBACK <br />USE ZONE LOT AREA <br />TYPE OF CONST. OCCUPANCY GROUP <br />SIZE OF SLOG, NO. OF STORIES <br />FIRE ZONE BASEMENT BEDROOMS <br />- -" APPROVALS <br />T. ENVIRONMENTAL CHECKLIST <br />2. BUILDING PLANS <br />T FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 CRADINCIFXCAVATION B CLEARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />S <br />RUft YARD 5 <br />VACANT SITE <br />OYES ONO <br />NO OF DWEL <br />MAX OCC. LL <br />FIRE SRFDKI <br />REQUIOYFS ONC <br />BY <br />DATE <br />APPI (CATION ACC. BY PLANS --CHECKED APPR. FOR ISSUANCE <br />9-1-79 <br />I H EBY CERTIFY THAT I HAVE READ ANQ�Z%AMINED 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 />Oh 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} j ] <br />X C / <br />MECHANICAL _ <br />NO. TYPE Of EQUIPMENT FEE <br />AIR COND UNITS-H P FA <br />BOILERS -HP EA <br />GAS FIRED A C UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS -BTU A <br />WALL HEATERS -BTU. M <br />UNIT HEATERS -BTU. M <br />EVAPORATIVE COOLERS <br />VLN I ILAIIU" r— <br />RAKE HOOD �- <br />AIR HANDLING UNIT- C F M —� <br />STOVE <br />METAL FIREPLACE A CHIMNEY <br />SUBTOTAL $ <br />PERM); S <br />�— IOTA) RF <br />PLAN CHICK NUMBE PLAN CHECK <br />II RECEIPTT NO <br />FEES VALUATION FEE <br />BUILDING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />U.B.C. <br />PENALTY SEC, TOUR) <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />