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everett PERMIT IWO <br />21 <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALT 359-8715 <br />'VERETT. WA 9B2D1 <br />❑COM�INA710N 7(BUILDING <br />❑MECHANICAL <br />❑PLUMlING <br />PERMIT NO. <br />pE.tt���� <br />iM�E�R�►IItM <br />MAII ADDLE SS <br />NAIUfIAIN� I '�j0 CARJ�iO� <br />CITY <br />Lroftp ' <br />ZIP <br />?i31 / <br />PHONE <br />tS7.O sP0 L <br />ARE Hill Cl OR DISICNIR <br />MAIL ADORISS, <br />CITY <br />ZIP <br />(HONE <br />GINI MI CONTRACTOR <br />MAII ADDRl SS <br />CITY ZIP <br />PHONE LICENSE 1 <br />SB LF <br />NICHNHCAL CONTRACTOR <br />MAIL ADDRESS <br />CITY (IP <br />PHONE LICENSE P <br />PHONE LICENSE / <br />PIL'MBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />CLASS OF WORK <br />[:]NEW ❑ADDITION <br />,�/ <br />❑ALTERATION )ERE PAIR <br />J <br />❑DEMOLITION ❑FENCE ❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />S'A1 ATION OF WORK <br />S �. ' C-h — <br />DESERT I WORK it - ICOOR Gf-�hP <br />PROPOSED USE OF RUILDING <br />IIJ <br />1 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 O NTRACTOR OR AUTHORIZED AGENT DATE �- <br />ALow�u. <br />LFCALry SCRIPTION OF PROP(RT";SHOWN BELOW OR AITMH FOUR COPIISI <br />MBM �L4T OF 'fT' <br />LOTH BLOCK a <br />108 ADDRIS <br />r E <br />►LUM G <br />MECHANIC- L <br />NO. <br />TYR OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIETI <br />AIR COND UNITS-H I EA <br />BATHTUB <br />REFRIGERATION UNITS -HP EA <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-0 T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRY TRAY <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 />STOVL <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE L CHIMNEY <br />SINK (SERVICE -BAR. ETC 1 <br />EUR TOTAL <br />SUBTOTAL / <br />PERMIT <br />/ <br />PERMIT / <br />TOTAI.FEE <br />/ <br />TOTAL <br />FEE / <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />fit <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ❑NO <br />FEE/ <br />VALUATEON <br />FEE <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 />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES ❑NO <br />MECHANICAL <br />APPROVAL/ <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />USC <br />SIC Wxm) <br />3 BUILDING PLANS <br />TOTAL <br />7 FIRE HYDRANT <br />A FIRE PROTECTION SI STEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGIf %C'AVA710N/ CLF ARINGIGRUBflING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPLE FOR ISSUANCE BY <br />i <br />