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APPL <br />CA <br />TAR EY.IOP88l1 `-C O N S T R UDC T 1 I V4 [VPTDH <br />CITY OF <br />everett PERMIT e <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259"8745 <br />EVE RET T. WA 98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />city �yFrzFTt 30 <br />z1K-rmoa,—CNY ,wl PZS4 ��o/ <br />�ie7r q <br />ARCIIIIECI OR DI SIE.NI R MAIL ADDRESS CITY ZIP PHONE <br />L7EGK )Wr=TS 16 <br />GENE RAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CLIP ZIP INOM LICINSII <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICINSE <br />CLASS OF WORK <br />❑NEW ❑ADDITION <br />VALUATION OF WORK <br />1 32o0 <br />TERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑51GN ❑GARAGE ❑BUILDING RELOCATION <br />DI SCRIBE WORK <br />P—j5L0C4]E eVS77A)& E"rcl/�K <br />PROPOSED UH Of Oil LIING <br />L/62d(0y <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 PLRMIT 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 AUTIInRIZED AGENT DATE 77 <br />x t <br />LEGAL Of SCRIPIION Of PROP)R I IS DOWN RI IOW OR AI IACII FOUR CONES) <br />LG; _ BLOCK _OF <br />-O h <br />108 n[ OFFSS <br />11K HoYr <br />PLUMBING <br />MICHAh(IfAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (IOLIE II <br />AIR COND UNITS-H P. FA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP FA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-B T.0 AI EA <br />DISWAS14ER <br />WALL HE AT III U M <br />LAUNDRY TRAY <br />UNIT HEAT FRS-B I U M <br />CLOTHES WASHIR <br />(VAPORATIVE 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 />SIOVF <br />ROOF DRAINS-"RAMLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC 1 <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT f <br />TOTALFEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR I'ARD SETBACK <br />PLAN CHECK NUMBER <br />�y 3���- <br />PLAN <br />2 F'.F <br />CHECK FEE <br />RFCEIP 6 63-ov <br />C <br />USE ZONE <br />LOT AREA <br />VACANT SIIE <br />OYES ONO <br />FITS <br />VALUATION <br />RE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />J <br />SIZE Of BIOG <br />NO Of STORIES <br />MAX OCC TOAD <br />PLUMBING <br />FIRE ZONE <br />BAS[MF Nf <br />flI OROONIS <br />TIRE SPRINKLERS <br />REQUIRED <br />YTS E7N0 <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PE NAI.iY <br />U B c <br />SIC 10NA1 <br />2 BUILDING PLANS <br />TOTAL <br />7 FIRE HYDRANT <br />R FIRE PROTECTION SYSTEM <br />S GRADINGIEXCAVATIONLCL[ARING.GRUSBING <br />PERMIT 7AIIDATION <br />WHLN PRO°ERLY VALIDAT(D (IN 1111S SPACE) THIS 15 YOUR PERMI, <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALIH DISTRICT <br />APPLICATION 777= <br />91 79 <br />