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s APPLICATION fOR <br />everett INSTRUCTION <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES PERMIT <br />CITY HALL 2594R745 <br />EVERET7, wA 9B2oT OM,BINATION ❑ BUILDING <br />ON'N�- µrG i r14 <br />A1AIL AUDRF SS _lavv\c S, 1 r,l'v1e_ J79/7 (AJ&t nf- Y <br />/�/ CITY <br />K <br />ARCHITECT OR DESIGNER <br />❑MECHANICAL <br />❑PLUMBING PERMIT NO. <br />ZIP "NONE <br />f.YJ33 s�eA <br />TT <br />_Tm mrf SSI OY� 1� <br />Iles IA <br />MAIL ADDRESS CITY <br />aaL� --TT <br />El 9 �/QckS RyL <br />ZIP <br />t <br />PHONE <br />GENERAL CON ACO <br />MAIL ADDRESS <br />sS 3 a vy <br />,° he yIec"c/e c/ <br />CITY <br />ZIP <br />PHONE LICENSE S <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />LIP <br />PHONE LICENSE S <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />aL <br />PHONE LICENSE <br />CLASS OF WORK <br />2/NEW <br />_. <br />❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE <br />❑SIGN ❑GARAGE ❑mill nlNr. RFI nrATInN <br />FV�lO,000, <br />DESCRIBE WORK <br />PROPOSED USf OF BUILDING // <br />S I n I� - o V. re S I CIe F ce <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 11/u/79 <br />X , <br />LEGAL DESCRIPTION OF PROPERTY (SHOWIN BELOW OR ATTACH FOUR COPIES) <br />/ <br />LOT 1 BLOCK�OF �h o/sc� 0 .Ih6 eI� a;,E <br />E <br />(tirA o-� A t <br />h�ccrcl ecl (/aI. `) s , k7 <br />Fr <br />Corel "Y S iA. 4.SCSI . <br />108 ADDREyy ff <br />• J- b b e l s o rl D h I' v V_ (leE-c-'It- <br />PLUMBING <br />MECHANICAL <br />NO. <br />j <br />TYPE OF FIXTURE <br />WATER CLOSET(TOLIET) <br />FEE <br />(,O <br />NO. <br />TYPE OF EQUIPMENT <br />AIR COND. UNITS-H.P EA <br />FEE <br />BATHTUB <br />QD <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY (WASH BASIN) <br />C90 <br />BOILERS-H,P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP. <br />DISWASHER <br />CEO <br />U O <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />1VALL HEATERS-B.T.U. M <br />5 <br />DD <br />LAUNDRY TRAY <br />UNIT HEATERS-B.LU. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />J <br />- <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />b <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNIT- C.F.M. <br />3 <br />OO <br />00 <br />Op <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS -RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC { <br />v <br />SUB TOTAL <br />C7 <br />SUB TOTAL $ <br />Orj <br />PERMIT S <br />PERMIT S <br />SIOL YARD SETBACK <br />, / <br />O <br />TOTAL FEE <br />STREET SETBACK <br />/' <br />RLAR YARD SETBACK <br />�' <br />TOTAL <br />PLAN CHECK NUMBER <br />-7O91 <br />FEE y Q <br />PLAN CHECK FE E(7� <br />FF�33. Sb R�FPLN <br />cp <br />USE ZONE <br />�..�/ <br />LOT AREA <br />5816) <br />VACANT SITE <br />DYES XNO <br />FEES <br />VALUATION <br />_ <br />FEE <br />TYPE OF CONST. <br />SIZE OF RLDO L <br />OCC'IPANCY GROUP <br />NO. OF STORIES <br />NO. OF WELLING UNITS <br />MAX OCC. LOAD <br />BUILDING <br />y9tl cc, <br />O0 <br />PLUMBING <br />FIRE ZONE _ <br />Nz�) <br />BASEMENT <br />JA f� <br />I BEDROOMS <br />.J <br />FIRE SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />Q <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />N A <br />PENALTY <br />U B.C. <br />SEC 30Na) <br />2. BUILDING PLANS <br />1. FIRE HYDRANT <br />70TAL <br />2 I r7 <br />J I <br />vd <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROP[R LT %AI IDA TED (IN THIS SPACE) THIS IS YOUR PERMIT <br />%Q S'FJ. .. -,. I.a l'� �li. /•.'. <br />S GRADING/EXCAVATION B CLEARINGIC.RUBBINC <br />b. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENTS. <br />HEALTH DISTRICT <br />C NY <br />APPLICATION ACPLANS CHECKED BY <br />V. a <br />APPR IOR ISSUANCE 11Y <br />