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APPLICATION FOR <br />W®NSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />FVERETT, WA 98201 COMBINATION <br />0 <br />III <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />I'IL�A-G'G%Pr - ••�• MML AUIIKI51 <br />S. L (,J,-, A <br />LITT <br />LEI' <br />14'133 <br />_JawY <br />I-VI'Lle_ III 7TO7 <br />_Sa.cHit- <br />ARCHITECT OR DESIGNER <br />:.MIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />_1. W1 �rc5Si DYE <br />�cs in;� `11� <br />3��S <br />6[NIR.AEILCONIIIkACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE/ <br />/ <br />1 G tle. C�CCICIPCT <br />All OIANICAL CONTRACTOR <br />MAIL ADDRESS <br />CIO <br />ZIP <br />PHONE LICENSE <br />PIUMBIND CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHUNI LICENSE <br />-SASS OF WORK <br />2NEW []ADDITION <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE <br />❑SIGN ❑GARAGE <br />❑BUILDING RELOCATION <br />VALUATION Of WORK <br />L qG,— <br />DISCRIBE WORK <br />PROPOSED USE OF BUILDING 11 <br />51 n I `C * U »` � Ij (c S I cir'c' <br />1 HEREBY CERTIFY THAT I HAVE READ AND EX MINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TR ND CORRECT ALL <br />PROVISION OVERNING THIS TYPE <br />K WILL BC COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NUT 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 If IL/ Z,V IF <br />x <br />ILGA1DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />.m 22 <br />BLOCK —OF ( a 0 ' ' °j1 <br />// <br />Ic,r/� t c c. d fd I/d . 9 a% Ek l ..f 7 <br />E (S _ 7-5 —IT- <br />tj <br />on ADORE SS <br />1,2,-; n v� — C ALP) P <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FIE <br />s <br />W'AUR CIOSET ITOLIETI <br />('J(J <br />AIR COND UNITS -II P LA <br />.3 <br />IMIHTUB <br />J' 0 <br />REFRIGERATION UNITS-11 P. EA <br />1Y <br />I AVATORV(WASH BASIN) <br />(9D <br />ROILIRS-HP FA <br />SHOWER <br />GAS TIRED A UNITS -TONNAGE EA <br />KIICHIN SINK A DISP <br />QO <br />IORLIDAIRSYSIIMS-RTU. MEA <br />DISPVASIHR <br />U <br />WALL IHATLRS-BTU M <br />LAUNDRY TRAY <br />UNIT HLA/ERS-B T.U. M <br />C101IRS WASHER <br />0 <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />00 <br />CIOTHES DRYERS <br />3 <br />OG <br />URINAL <br />- <br />VENTILATION FAN <br />OG <br />DRINKING FOUNTAIN <br />— <br />RANGE HOOD <br />Oo <br />I LOOR DRAIN <br />AIR HANDLING UNIT- CENT <br />VACUUM BREAKERS <br />SIOVF <br />ROOF DRAINS -RAINL LADE RS <br />MI IAL FIREPLACE &CHIMNEY <br />SINK (SERVICE -BAR. L TC ) <br />SUB TOTAL <br />SUB TOTAL S <br />QC <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL it[ <br />S <br />op <br />TOTAL FEE S <br />Q <br />dUi YARD SETBACK <br />/O' � G / <br />SIR[I T SI IIIACK <br />/ <br />NI. All YARD SETBACK <br />.�1 <br />PLAN CIIi CK NUMBER <br />t PLAN <br />11`33.5-t' <br />OUCK ILL <br />RE IP7p <br />PLN <br />1S1 ZONE <br />'IJ-1 <br />LOT ANLA .is <br />58/0 i' <br />VACANT $Ill <br />DYES MNO <br />TIES <br />VALUATION <br />FEE <br />IN Of CCONST, <br />�-N <br />OCCUPANCY GROUP <br />-3 <br />NO 01 [}WELLING UNITS <br />I <br />BUIIUING <br />SpjO <br />2101 <br />oC <br />IZI OF BLDG. <br />1 1 <br />NO, OF STORIES <br />.2- <br />•.tA' OCC LOAD <br />rulAuunc <br />Vi <br />IRI ZONE <br />'� <br />BASEMENT <br />J.L.•l1, <br />III DROOMS <br />?j <br />HRL SPRINKLE IRS <br />RI CLARET) <br />;vtx NNO <br />MIC11. %I('AI <br />APPROVALS <br />BY <br />DATE <br />OIHIR <br />I NVIRONNHNIAL CHECK LISTUsc <br />N A <br />PINAI0 <br />sit PONT) <br />BUR DING PLANS <br />TOTAL <br />IIRI HYDRANT <br />IIRI PROTECTION SYSTEM <br />PERMIT VALIDATION <br />Will N PROPI RLY VAT IDATI I) TIN THIS SPACE) THIS IS YOUR PERMIT <br />L` Op /- D n3 �(e r`M E / , 0 I_" <br />I / <br />ejeaf,a <br />LNAOINC.1 yr VAIION A is E ARIRGIGRUIIBING <br />DRAINAGE <br />ENVIRONMENTAL IMPACI S7A71MINT <br />III. A, TH DISTRICT <br />APPLICATION ACC BY 1'lANS CIEICKI U BY <br />AI'I'N ION ISS'IANI 1 In <br />