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-APPLICATION FOR lYBFCN <br />the '°`"" <br />cl"OF CONSTRUCTIOi. e <br />OITY O <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA98201 OCOMBINATION ❑ BUILDING ❑MECIWW�IIG#P��❑PLUMBING PERMIT NO. <br />ON'Nta MAIL ADDRESS�7 o,41 � L�11 ZIP PHONFJ <br />ZIP <br />rHD [ <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />IF <br />ou/i i ,Z77/ re - <br />CLASS OF N'ORK <br />❑NEW ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Or NORK <br />Pell <br />l <br />DESCRIBE WORK <br />A <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSH)USE Or BUILDING <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISION$ OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />cscRlPnoN or lRl aOrY I511 EI 'N flOw OR TACN TOUR <br />LEGAL Dl <br />COPIESI <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />! <br />LOT _7 BLOCKOF t <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 />/7 <br />108 ADDRESS <br />o_lp I <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (IOLIETI <br />AIR COND UNITS- IT P. EA <br />REFRIGERATION UNITS -HP EA <br />RATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />GAS FIRED AC UNITS -TONNAGE EA <br />SHOWER <br />FORCFU AIR SYSTEMS—B T U M EA <br />KITCHEN SINK A DISP <br />WALE. HEATERS —BTU M <br />DISWASHER <br />UNIT Hf A1ER5—BTU M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />WATER HEATER <br />CLOTHES DRYERS <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT— C F M <br />FLOOR DRAI�__. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLLADERS <br />METAL FIREPLACE X CHIMNEY <br />SINK (SERVICI —BAR. TIC) <br />SUB TOTAL B <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />Slpf YARD SETBACK <br />TOTAL FEE <br />STREET SETBACK <br />S <br />RI AR YARD SL 11UCK <br />PLAN CHICK NUMBER PLAN <br />CHECK FEE <br />RECEIPT NO. <br />FEE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />TYPE Of CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ <br />O <br />SIZE OF BLDG <br />NO OF STORIES <br />MAK OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERSRIQUIR <br />MECHANICAL <br />❑YFS ONO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UB <br />SEC C. <br />SEC. RDXRI <br />11 <br />�� <br />l BUILDING PLANS <br />V <br />TOTAL <br />T FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDON <br />WHEN PROPERLY VALIDATED (IN THIS SPACFI THIS IS YOUR PERMIT <br />�_ / <br />5 GRADINGIE XCAVATION 6 CLE ARINCIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />