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FM EVWV"R <br />GTY OF <br />APPLICATION FOR.. <br />-CONSTRUCTION,.-) <br />everett PERMIT <br />DEPT OF COMMUNITY DEVI LOPMENT SERVICES <br />CITY HALL 2598745 <br />PYBfRM <br />e <br />EVERETT, WA9B201 <br />COMBINATION ❑ BUILDING <br />❑MECHANICAL <br />PLUMBING <br />PERMIT NO. <br />OWNER <br />MGr1 n <br />MML nUDxl ss ,.� <br />ei (ka(t �5ot( ��CLvl1 <br />TIFF <br />LwP"LRU_ <br />711, <br />(X-v1 <br />PIIONI <br />z),�0Ll <br />OR M SICNI R <br />MAIL <br />CITY <br />GI NI RAL CONTRA( FOR MAIL&DURESS CITY DP rNONE LICINSII <br />MICHANICAI CONTRACTOR MAIL ADORISS CITY LIP rNONt LICENSEE <br />PLLIMRING CONTRACTOR MAIL ABORT SS CITY ZIP PHONE LICENSE <br />1-(;-%-n.r,J (Itr,II;,,•, <br />CUSS OF WORK <br />❑NEW E]ADUII ION ❑AI.I CR AT ION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑ HUI LDING RELOCATION <br />VAIUAI ION OF WORK <br />OISIRIIII `AORA <br />M fN II 2.In Clr C (l.. <br />rElor7Ous1 OF xun 'IN(; <br />(Z <br />I HERE I BY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME 10 BE TRUE AND CORRECT ALL <br />PROVI5IONS 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 70 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 AUIIIORIZED AGENT DATE <br />X 1 _v �LUCk.E P Sf _ <br />LEGAL DESCRIPTION OF PRON FLY IS1IOWN RDOW OR ATTACH FOUR COPIES) <br />LOT _RIOCK_OF <br />TOR nDOR155 <br />Y CA ✓Y d <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE Of EQUIPMENT <br />FEE <br />WATER CLOSIT (TOLII II <br />AIR COND UNITS-14 P LA <br />BAIHIUR <br />RIIRIGERA.IIONUNITS—TIP EA <br />LAVATORY (WASH BASIN) <br />ROLLERS-111" IA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS —BTU MLA <br />DISWASHER <br />W'ALLWAIERS—BTU M <br />LAUNDRYIRAY <br />UNIT 11(AIIRS-11IU M <br />CLOTHES WASHER <br />IVAPORAIIVf COOLERS <br />WA11R HEATER <br />CEOHIIS OPYIRS <br />URINAL <br />VI NTILATION 1 AN <br />DRINKING fOUNIAIN <br />RANGE FLOOD <br />I LOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BRFAKIRS <br />STOVE <br />ROOT DRAINS—RAINIE ADI RS <br />AIE IAL IIRLPLACL A CHIMNEY <br />SINK ISERVICI—BAR, TICE <br />SUBTOTAL <br />SUBTOTAL B <br />PERMIT S <br />PERMIT B <br />TOTAL FEE B <br />TOTALFIEF S <br />SIDE VARO St TBACK <br />SIREIT SETBACK <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 />DYES )INU <br />FEES <br />VALUATION <br />FIE <br />TYPE OF CONS1 <br />OCCUPANCY GROUP <br />NO Of DWLIIING UNITS <br />BUILDING <br />S <br />SIZE Or HEDG <br />NO Of STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE 7UNI <br />BASEMINI <br />111 URJOMS <br />IIRE SPRINKLERS <br />RIQUIRID <br />FTYIS FIND <br />M(CHANICAt <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENYIRONMENTALCHECKLIST <br />PENALTY <br />UBC <br />SIC 103(a) <br />2. HUI; DING PLANS <br />TOTAL <br />TIRE HYDRANT <br />a FIRE PROIECIIONSYSIEM <br />5 GRADING/[ XCAVAIION A CIEARINGIGRURIUNG <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACEI 7I/1S 15 YOUR PERMIT <br />6 DRAINAGE <br />7. TN5'IRONMLNTAL IMPACT STAIIMENT <br />R HEALlH DISTRICT <br />APPLICAI ION ACC. BY <br />PLANS CHE CKLD BY <br />APPR FOR ISSUANCE BY <br />91 79 <br />