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r:7 <br />OW EE0gFsen <br />CITY OF <br />APPLICATION FOR <br />CJNSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2594745 <br />EVERETT. WA 98201 ❑COMBINATION <br />duA11111lltw116. <br />BUILDING ❑MECHANICAL ❑PLUMBING <br />CITY ZIP <br />1&4 cw►%t goft*r ?ii1/ <br />CITY ZIP <br />PERMIT NO. <br />•ose <br />GENE MI COHTEUCt011 MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 1 <br />CI ASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION EPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />Al TION Of WORK .• <br />I\. -,Sa - <br />DISCI WORK <br />L . CAOQ \ E�f�7f� <br />PROLIStD USE Of BUILDING <br />w <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 CONSTRU TION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE O NTRACTOR OIL AUTHORIZED AGENT DATE ��/at <br />ow�w <br />SCRIPTION OF PRONRTY [SHOWN MLOW OR ATTACH LOUR COI!ISI <br />we <br />ERB� r ; "1'r <br />Lot�stocK�a <br />ION AoDRLE <br />r E <br />PLUMSIBIC <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE. <br />NO. <br />TM Of EQUI►MINT <br />FEE <br />WATER CLUSFT (TOLIETI <br />AIR COND UNITS—H P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P FA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK L DISP <br />FORCED AIR SYSTEMS—B i U M FA <br />DISWASMER <br />WALL HEATERS -BTU M <br />LAUNDRY TRAY <br />UNIT HEATEKS-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 />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLFADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR, ETC I <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT <br />E <br />FERMIT S <br />TOTAL FEE <br />B <br />TOTAL <br />FEE S <br />SIDE YARD SETBACK <br />STREET ',(TRACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO, <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BL)G <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />HE GROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES ONO <br />MECHANICAL <br />APPROVALS <br />ET <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC 303(N) <br />2 BUILDING PLANS <br />TOTAL <br />7 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />S GRADINGIE KCAVAI ION& CIE RINGIGRUBRING <br />P[NMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC. 61 PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />i <br />