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IM Enrprrin <br />an of <br />everett <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2598745 <br />EVERETT. WA 98201 ❑COMBINATION <br />PPLICATION FOR <br />CONSTRUCTION <br />PERMIT <br />p BUILDING ❑MECHANICAL ❑PLUMPING PERMIT NO. <br />OWNER MAIL ADDRESS CITY ZIP PHONL <br />L I< CARLS�A/ 77D-r 6/'0 - u1 I=LJFp£77- CAN 9h?.o3 3S--s-$;7-If <br />ARCHITICT OR DISIGNIR MAIL ADDRESS CITY 71P PHONE <br />GENh+ALCONTRACIOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSES <br />MECHANICAL CONTRACIOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE I <br />PIC,IBfM1G CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSES <br />CLASS Of WORK <br />❑NEYV ❑ <br />E�ADDITION }ey ALTERATION ❑REPAIR <br />[]DEMOLITION ❑FENCE ❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />LTLUATION Of WORK <br />DESCRIBE WORK <br />i.. " K —. ,F O FO/ d/ E 4/APTN HELM UL <7V UE <br />V <br />PROPOSED USE DI BURRING <br />LEGAL DESCRIPTION 01 PROPIRII ISHOx'N BELOW OR ATTACH IODR COPIES) <br />LOT _BLOCK —OF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />E.// <br />Q.L-- <br />SOB ,DOR11s , <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIETI <br />AIR CONE) UNITS -HP EA <br />BATHTUB <br />REFRIGERATION UNITS -HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK 6 GIST <br />FORCED AIR SYSTEMS-8 T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-9 T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE MOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE pp <br />%a <br />ROOF DRAIN$-RAINLF ADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR. ETC I <br />SUB TOTAL <br />SUB TOTAL S <br />ja <br />PERMIT <br />S <br />PERMIT S <br />U <br />dC <br />TOTAL FEE <br />S <br />TOTAL <br />FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />C FEE <br />REECEICEI PT NO. <br />US[ZONE <br />LOT AREA <br />VACANT 511E <br />❑YE5 ONO <br />FFFf <br />VALUATION <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 />PLUMBINGFIRE <br />ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE <br />REQUIREDK'.E R$ <br />nYFS nNO <br />MECHANICAL <br />APPROVALS <br />IT <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC J0J(a) <br />2 BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />R FIRE PROTECTION SYSTEM <br />5 GRADINGEXCAVATION B CLEARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED SIN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />S HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />AFTER FOR ISSUANCE BY <br />91 79 <br />