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APPLICATION FOP <br />EAT EYeryreen CITY OF 4P <br />C O N S T R U C T I O1 9 <br />everett <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDkrsS CITY ZIP PHONE <br />uv Q'aL au: l�L AU i-„ �T qbzL� 2SZ-9)4U <br />ARCHITECT OR DESIGNER <br />CITY <br />Gf NLRAL CPJNIRACiOR <br />dA.o <br />MAIL AOOR[SS <br />l�k,a <br />PHONE LICENSE a <br />...r\LI�JNLJ <br />ZEE 4�i.� l-� <br />WL <br />�y�1 <br />QZIEP �� <br />lV <br />C VoIl0 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />LIP <br />PHONE LICENSEE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE LICENSEE <br />CLASS OF WORK( <br />AADDITION <br />❑NEW <br />❑ALTERATION ❑REPAIR <br />❑DEMOLITION ❑FENCE <br />❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />F l0l`(bb <br />DESCRI/EWORK <br />PALL 00 C--CA_ZkA&L_ <br />DiINI OCL IZZ)b, <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOTyEILOCK 10 OF 6SuRPf7AL 24 AIODITicA/ <br />A �L�"7LLs7i <br />IOB ADDR[SS n <br />4LuZ1ttYr <br />do E EvtTzerE �ittzc 3 <br />PLUMBING <br />NO. TYPE OF FIXTURE FEE <br />WATER CLOSET (TOLIETI <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK A DISP CCU <br />DISWASHER C:LJ <br />LAUNDRYTRAY _ <br />CLOTH IES WASHER <br />WATER HEATER <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 �TOR OR AUTHORIZED AGENT DATE <br />X 3iro�ez <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FLE <br />AIR COND. UNITS—H. P. EA <br />REFRIGERATION UNITS—H.P. EA <br />BOILERS—H P. EA <br />GAS FIRED A UNITS —TONNAGE EA <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />WALL HEATERS—B.T.U. M <br />UNIT HEATERS —El T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYEBS <br />URINAL VENTILATION FAN <br />DRINKING FOUNTAIN RANGE HOOD S"L <br />FLOOR DRAIN AIR HANDLING UNIT— C.F M. <br />VACUUM BREAKERS STOVE — <br />ROOF DRAINS —RAINLEADERS I I I METAL FIREPLACE L CHIMNEY <br />TOTAL FEE <br />YARD 5 <br />Co <br />USE ZONE LOT AREA <br />TYPE OF CONST OCCUPANCY GROUP <br />y;-" tZ-3 <br />SIZE OF BIIDG NO. OF STORIES <br />J & t.li 4, D 7,J <br />FIRE ZONE BASEMENT Iik ONOOMS <br />APPROVALS <br />1. ENVIRONMENTAL CHECKLIST <br />1. BUILDING PLANS <br />3 FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />S GRADINGIEXCAVATION SCLEARINGIGRUBBING <br />6 DRAINA(.f <br />.\ IRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />--�� <br />APPLICATION ACC. BY PLANS CHECKED BY <br />CL 6) 1 lc. G <br />S TOTAL <br />REAR YARD SETBACK PLAN CHECK NUMBER <br />FEE <br />VACANT SITE FEES •7 <br />DYES 2146 <br />NO OF DWELLINC <br />I <br />MAX. OCC. LOAD <br />BY I DATE <br />APPR. FUR ISSUANCE BY <br />L-cA <br />s <br />s <br />PLAN CHECK FEE <br />RECEIPT 110 <br />3 Isgos, <br />BUILDING <br />S/O✓ LTn tV <br />Lam/ <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />U.B C. <br />SEC. 303(a) <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACE) THIS 15 YOUR PERMIT <br />n.1.70 <br />