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APPLICATION FOR <br />Ens EYerpreen CONSTRUCTION <br />ma, OF <br />evrerett PERMIT <br />Of PT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-874S <br />EVERETT. WA9B201 rfnuAINATION R BUILDING ❑MECHANICAL ❑PLUMBIP'G PERMIT NO. <br />GENERA NTRACTOR MAIL ADDRESS CITY Zlv vnone uAmn <br />I <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY [IP rnunl 1-- 111 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY llp PHONE LICENSE <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION AENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VAIUAIY F WORK <br />S / 3.00 <br />WORK <br />"ED USE Of BUILDING <br />IF AL DESCRIPTION OF PROPERTY BF��OOW OR AFT CHIOURCOPILS1 <br />yC, sl� �A� <br />BLOCK 1L OF `-•+�/ �- <br />g/ 3p <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 AGENT DATE <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTUPT <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ETOLIET) <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS-11 P. EA <br />LAVATORY (WASH BASINI <br />BOII ERS—H P EA <br />SHOWER <br />GAS FIRED A C. UNITS —TONNAGE SA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS—d T U MLA <br />DISWASHFR <br />WALL HEATERS —BTU AI <br />LAUNDRYTRAY <br />UNIT HFATERS—BTU. 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 />FLOOR ORAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLE ADERS <br />METAL fIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC <br />GB TOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />FOTALFfE <br />S <br />TOTAL FIT 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 />OYES ONO <br />FEES <br />VAWATION <br />FEE <br />TYPE OF L NST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BIOROOMS <br />FIRE REQUIRED <br />OYES ONO <br />MECHANICAL <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />ILBC <br />SEC. 209.F) <br />_ <br />2. BUILDING PLANS <br />TOTAL <br />- <br />] FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINCIEXCAVATION B CLEARINGIGRUBBING <br />6 DRAII.AOE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPUCAT ION ACC BY <br />PLANS CNfCK[D RY <br />APPR FOR ISSUANCE BY <br />91-79 <br />