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! <br />0 <br />ACf.��STRUCTION � <br />lhc F.rrr!vrrn � <br />�everett PERMIT <br />DEPT. OF COMMUNITY DEVEIOPMENT SERVICES <br />CITV HALL I59-8715 <br />EVEREtT.w�9em� ��OMlINATION ❑BUILDING ❑MECHANICAL ❑PLUMBING PERMITNO. <br />OWNFR M�IL AODXF55 CITY ZIP PMON[ <br />,? y (aQ r`'1 �q 6 /•., G yzo � !, f�. .O.D� �8z�s <br />i <br />� <br />everctl <br />e <br />ARCHRFCTOROESIG/NFR I / � MAIUDDAl53 / n CI7Y ,_ ,/� ZIP PMONE GENEKH��3� K <br />�T�.�erd 1 �ioa-�� Sery:�. 1.�20 Ra��' t ��ei.!l �/J c18�-�T 3i3'SbC� <br />GFNERAICONTR�CTOR MAIU�OR65 C11V 21P PNONE LICENSf I <br />MECN�NIUL CONTRACTOR M�II ADDRE55 ��TY LIP PHONF IICFNSE 1 <br />PLUMBING CONTM[TOR M�IL ADD0.E55 CIIY ZIP PMONE LICENSE 1 <br />CUSS Oi WORK �� <br />❑NFW ❑ADDITION ❑ALTERATION I.NREPAIR ❑LEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑bUILDING RELOCATION <br />VAlUAT10N OF WORIb p <br />+ Rnnn- _ <br />�, <br />rRorosro use ov auu �� <br />S.N � � a ' <br />LELAL OESCRIPTION Oi PI�OPERTY 1 <br />�or � ei«c `?� or <br />�/2 d <br />►LUM�ING <br />L DISP. <br />RRMIT <br />�I . � I SIZE OF BLDG. NQ OF <br />FIRE <br />', AlMOVAlS <br />1. ENVIRONMENTAL CHECK LIST <br />3. BUILDING PIANS <br />7. FIRF HYDRANT <br />�. FIRE PROTECTION SYSTEM <br />5. CRADINGIL%CAVATION S Clf ARINGIGRUNflING <br />6. DRAINAGE <br />7.FNVIRONMENTALIMPAfTSTATEMENT <br />s. HEALTH DISTRICT <br />AI'PLIC4lIO�nCC III' Pl��c(IIItKfPl11' <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 />fOURCOPI 51 PROVISIONS OF LAWS AND ORDINANCES GOVERNINC THIS TYPE <br />��� �� �` �� F WORK WILL 8E COMPLIED WITH WHETHER SPECIFIED HEREIN <br />R NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />CIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAI. LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONT0.AGTOR j�lt AUTHORIZED AGENT DATE <br />[7 <br />YARD <br />VACANT SITE <br />❑YE$ ❑NO <br />NO. OF DwEI <br />�r � DAiE <br />I�SI in`:CI 111' <br />NO. <br />AIR COND. UNITS—HP. EA <br />REFRILERATION UNITS—N.P. EA <br />BOILERS—H.B EA <br />GAS FIRED A.C. UNITS—TONN�CE E� <br />FORCE� AIR SYSIEMS—B.T.LL M <br />WAIL HEATERS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />EVAPOkATIVE COOlERS <br />VENTILATION FAN <br />RANGENOOD <br />AIR HANDLING UNIT— C.F.M. <br />CHECK NUMBER <br />FFES <br />8 <br />8� <br />FEE <br />f <br />fEF I RECEIPT NO. <br />BUIIDING ° <br />PWMBING <br />MCCHANIGL <br />OTHER <br />PENALTY U.B.C. <br />SEC. ]03�a) <br />TOTAI <br />�E�MIT VAUDA710N ' <br />WHEN PROPERLY VAIIDATED (IN TMIS SPACE) TMIS I VOUR PERMIT <br />1f� 6���,GLc-t �! G�! !G^�C•c' ,L�+/r <br />