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rM E"11111NI) APPLICATION FOR <br />GITY OF CONSTRUCTION <br />everett PERMIT <br />ereren <br />e <br />DEPT OF COMMUNITY DEVELOPMENT SFP'; 2CES <br />CITY HALL 259-8745 <br />EVERETT. WA98201 <br />❑COMBINATION ❑ BUILDING <br />❑MECHANICAL <br />❑PLUMBING PERMIT NO. <br />OWNER <br />MA I ADORE 55 <br />CI15' <br />ZIP PHONE <br />(Glall < <br />/Owe/ L DO <br />f3os ,��96 gV <br />/ <br />%��3 <br />ARCHITECT OR OF SIGH R <br />MAIL ADDRI 55 <br />CITY <br />ZIP PHONE <br />G <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE) <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE F <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSEE <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR 14DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OI WORK <br />S <br />DLSCRIBI 55ORK /' / <br />VPGvvxov ✓r,w tit 1AC �6 n n[ !ice uc o <br />PROPOSED USE OF BUILDING <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 />x / b <br />Er. ESCRIPU N O PR PI' CH v 81 u Y R ATTACH FOUR COPIES) <br />Vir Im o� 0�' P��j ��, i �� <br />ICI _BICCA,1j1CI <br />// <br />mf i/ l l <br />LOB n ORE is <br />ZYa� rFSGr <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />SYAIIR CIOSLI IIOLIEI) <br />AIR CONE) UNITS —HP LA <br />BAIHIUB <br />REFRIGERATION UNITS —El P EA <br />LAVATORY (WASH BASIN) <br />IIOILLRS—IR P LA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />DIMVASHIR <br />LAUNDRY IRAY <br />FORCED AIR SYSTEMS—B T U MIA <br />WALL HIAIERS-8TU M <br />UNIT ILEATERS—BTU. M <br />CIOTHES WASHIR <br />EVAPORATIVE COOLERS <br />WMER HIAHR <br />CLOTHIS DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />1 LOON DRAIN <br />AIR HANDLING UNIT— C F Al <br />VACUUM BRLAKIRS <br />SIOVE <br />ROOF DRAINS —RAIN) L ADE RS <br />METAL FIRE PLACE A CHIMNEY <br />SINK (SERVICE —BAR. ITC) <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FFE <br />S <br />TOTAL FEE 11 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUAIBL R <br />PLAN <br />It[ <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONS' <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 />HASEMENT <br />BEDROOMS <br />TIRE SPRINKLERS <br />REQUIRED <br />IIYFS PNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHICK LIST <br />PENALTY <br />LI TIC <br />SFC )UUAI <br />2 BUILDING PLANS <br />TOTAL <br />FIR) IODRANT <br />4 FIRE PR011C1ION SYSTEM <br />5 GRADIN(; I K( A'AI ION A Cl E ARING,GRUIII;ING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />h DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8. H[ALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />ff <br />9.1.79 <br />