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IM EP.roMn <br />CITY OF <br />APPLICATION FOR <br />..CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-9745 <br />EVERETT. WA90201 <br />❑COMBINATION El BUILDING <br />❑MECHANICAL <br />❑PLUMBING PERMIT NO. <br />OWNER <br />LOU <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADORE 55 <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR <br />MAR ADDRESS <br />CITY <br />ZIP PHONE LICENSE E <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />PLUMPING CONTRACTOR MAIL ADOR[SS CITY ZIP PHONE LICENSE E <br />CLASS Of WORK tg'�}�y" <br />NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN aCARAGE ❑BUILDING RELOCATION <br />VALUAIION OF WORK <br />DESCRIBE WORK <br />U LI,C El 7VI 111._ �.- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSfUUSF Of PUIIDING <br />J NOPif14C� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />OOM S 7 `5�y,¢LL <br />AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF MOPERTYISHOWN BELOW OR ATTACH FOUR <br />COPIES) <br />PROVISIONS OF LAWS <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />'r P�qr cF I3EdE <br />1?BLOCK=OF � <br />!_V R4RK y. - <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT <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 ORAGENT DATE <br />AUTHORIZED <br />GI/ <br />ADDRESS <br />TDB <br />7�io Gam.+ u F—- <br />PLUMtING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIFT, <br />AIR COND UNITS-H P EA <br />REFRIGERATION UNITS-H P EA <br />BATHTUB <br />BOILERS -HP EA <br />LAVATORY (WASH BASIN, <br />GASFIREDAC UNITS-TONNAGEEA <br />SHOWER <br />FORCEU AIR SYSTEMS—B T U MIA <br />KITCHEN SINK 6 DI$° <br />WALL HEATERS -BTU M <br />DISWASHER <br />UNIT HEATERS-B T U AT <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />WATER HEATER <br />CLOTHES DRY[ITS <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR, ETC 1 <br />SW TOTAL <br />SUS TOTAL S <br />PERMIT <br />1 <br />PERMIT f <br />TOTAL FEE <br />S <br />TOTAL <br />FE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />RU0. YARD SETBACK <br />PUN CHICK NUMBER <br />PLAN <br />FFF S/ j <br />CHECK FEE <br />RECEIPT NO. <br />C, r �� r <br />-r � 7 <br />r �� � � <br />-' 3 <br />Yl l76 <br />'z .c— <br />USF ZONE <br />LOT AREA <br />VACANT Slit <br />'�gESO <br />FEES <br />VALUATION <br />FIE <br />�Z ZO <br />TYPE OF CONST -- <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />I.? Fi hrK� <br />M - <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />LU �� /- <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />LEI I1ROOn1S <br />FIRE SPRINKLERS <br />0.EOUIR D <br />MECHANICAL <br />— <br />11YF5 O <br />APPROVALS <br />my <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PL NAL IY <br />UPC. <br />SEC SOAR, <br />2 BUILDING PLANS <br />TOTAL <br />FJD <br />JC <br />T FIR[ HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />FERMIWHEN PROPERTY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />�� <br />5 GRADING! KCAVAT ION& CLLARINGIGRUHRING <br />& DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />AVYI ILA1lU:. Ail B, Tl �' ` "'�' ti I' 11, <br />" "' 11'B ISSI'AN( PY <br />