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IRA EWWW <br />CITY OF <br />APPLICATION FOR - <br />everett �ONPE MITTION <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2SM745 <br />EVERETT, WA 90201 ❑COMBINATION KOUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />`OWNER MAIL ADDR155 CITY ZIP PHONE <br />Me StzoioHE< 312o I,ew,rr !E�c.twii <br />ARCHITECT OR Df SICNfR MAIL ADDRI SS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSED <br />C�,LIJ%9Cdw Q.vL.,-;F 7- /Fr�wY 94 s 65-4-YoSo <br />MICHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE D <br />PIL'MAING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSED <br />CLASS Of WORK <br />❑NEW ❑ADDITION ALTERATION ❑REPAIR ❑DEMOLITIOP' ❑FENCE ❑SIGN ❑GARAGE ❑BUILDINC RELOCATION <br />vemenoN of woRK <br />DISCRIBI WORK <br />2.o' k <br />wN n <br />PROPOSED USE OF BULDINL <br />LavI,I„ t r_°t ri <br />LEGAL DESCRIPTION Of PROPFRTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />6Q W *CL 4AG[LKS S' E¢d� <br />LOT 1- S elocK�of <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION ANU 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 />�J <br />IOR ADDRESS <br />PLUMIING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />fit <br />NO. <br />TIEPE Of EQUIPMENT <br />f!E <br />WATER CLOSET (TOLIETI <br />AIR COND UNITS -HP. EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATOItY(WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE FA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-B T U M FA <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRYTRAY <br />UNIT HEATERS —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 DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK (SERVICE —BAR. ETC 1 <br />SUB TOTAL <br />Sul <br />TOTAL $ <br />PERMIT <br />B <br />PERMIT <br />S <br />TOTAL FEE <br />B <br />TOTAL <br />Fit B <br />SIDE VALLO SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO, <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />Fit <br />TYPE OF CONST <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 />fl1 OROOMS <br />FIE SPRRfIINNKLERS <br />YFS ❑NO <br />MECHANICAL <br />APPROVALS <br />By <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC. <br />SEC JoRR) <br />Z BUILDING PLANS <br />TOTAL <br />e FIRE HYDRANT <br />K FIRE PROTECTION SYSTEM <br />S GRADING) XCAVATION S CLFARINGIGRUBRING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED UN THIS SPACE) THIS 15 YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMf NTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />