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cirvn rhr`E APPLICATION FOR <br />CJNSTRUCTION <br />everett PERMIT <br />w <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA982o1 <br />❑COMBINATION ❑ BUILDING <br />❑MECHANICAL ❑PLUMBING <br />PERMIT NO. <br />OwNLR <br />XE6l <br />MAIL AIIURI ss <br />Gt/c Gc rQ `/fin/ �ybl.'tcvvycf <br />111\ <br />i-do/.� <br />71P <br />:FLCLl <br />PHONE <br />— <br />ARCIIIIECTORDIMGNIR <br />MAIL ADDRESS <br />(Ill <br />711' <br />PHONE <br />GENE RAI CONTRACIOR <br />MAIL ADDRESS <br />C:TI <br />LIP <br />PHONE LICE NSF <br />�45Cf 1 w", <br />/i% /l v��2/� /7/G, e'n 4 <br />03 <br />�26ys'•'/ <br />MECHANICAL CONTRACTOR MAIL ADDRI SS <br />tIl\ <br />ZIP <br />_ <br />PHONE LICENSER <br />PLUMPING CONTRACTOR <br />MAIL ADDRI SS <br />CIE\ <br />ZIP <br />PHONE IICE NSER <br />Cl ASS Of WORK <br />❑NEW ❑ADDITION OALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION �OF WORK 1 n / <br />/ 4 it?/cot <br />DISCRI HE WORK <br />PROPOSED USE Of <br />II WI DESCRIPTION Of PROPBLI'(SHOWN BELOW OR ATTACH FOUR (OPII SI <br />LOT <br />�7 -01 +a; 1z f 'I/ <br />N/71 fii I/Ll n F J <br />TOR <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 CO_. TRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PLUMBING <br />MECHANICAL <br />NO. <br />TY►F OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIFT) <br />AIR COND UNITS -HP EA <br />SAIHTUR <br />REFRIGERATION UNITS-H. P. EA <br />LAVATORY (WASH BASIN) <br />HOILERS-H i LA <br />SHCWER <br />GAS HR0, A C UNITS-TONNACE EA <br />KITCHEN SINK A DISP <br />FORCE 0 AIR SYSTEMS-H. T.0 MIA <br />DISWASH ER <br />WALE. UUILRS-H.I U n1 <br />LAUNDRY TRAY <br />UNIT If[ATERS-B 1 U M <br />CLOTHES WASHER <br />EVAPORAIIVE COOLI. RS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION TAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C. FM <br />VACUUM BREAKERS <br />STOVI <br />ROOF DRAINS -RAINLEADI RS <br />METAL IIRD'LAC[ A CHIMNEY <br />SINK (SERVICE -BAR. ETC I <br />SUN TOTAL <br />SUN TOTAL <br />f <br />PERMIT <br />S <br />PERMIT <br />IF <br />TOYALFEE <br />f <br />TOTALFEE <br />S <br />SIDE YARD S. TRACK <br />STREEC SETBACK <br />REAR T'ARD SETBACK <br />PLAN CHICK NUMHIR <br />-� <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USF ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />•EES <br />VALUATION <br />FEE <br />TYPE OF COAST. <br />OCCUPANCY GROAT' <br />NO OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG. <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE 70NE <br />BASEMENT <br />IiI DROOmS <br />FIRE SPRINKLERS <br />REQUIRED <br />FIVES LINO <br />MECHANICAL. <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PI NATTY <br />_ <br />U.BC <br />RFC JO71RI <br />I. BUILDING PUNS <br />1. FIRE HYDRANT <br />TOTAL <br />L[J <br />,� l <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS FPACE) THIS IS <br />YOUR PERMIT <br />5 GRAOINGIE %CAVATION A CLI. ARINGIGRUIIIIING <br />6 DRAINAGE <br />7. ERVIRONMENIAI. IMPACT SIAILMLNI <br />R HEALTH DISTRICT <br />APPLICATION ACC R1' I PLANS CHECKED B1' I APPR TOR ISSUANCE BY <br />9.1.711 <br />