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FAR EM'yrNB <br />'II. OF <br />'kPPLICATION FOR <br />CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 25"74S <br />EVERETT,WA98201 (],COMBINATION <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />S5 <br />ZIP <br />__7 <br />161 <br />G LNI RAl CON1RAETDR MMl AOORE 55 Clf\ ZIP PHONE LICENSE R <br />. ------- uai .nnuu (II\ LIP PHONE IICtNS[1 <br />PILIMTIING CONTRACTOR MAIL ADDM SS CITY ZIP PHONE LICENSE{ <br />C115S OI N'ORR <br />❑NEW ❑ADDITION ®ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />S'A IU AI ION OF WORK <br />I Soo R= <br />DISCRIS1 WORK <br />r _I 1 L A,_ <br />�•. T - <br />PROroSIDUSI OI RUIIDWG <br />LICAL DISCRIP110NOF PROPERIYISHONN MEDIA OR A71ACHIOURCOPIESI <br />LOT �RIOCA�OF <br />- <br />I HEREBY CERT4fY 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 />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSIT(TCLIFT) <br />AIR COME) UNITS -HP EA <br />BATHTUB <br />REFRIGERATION UNITS-H P YA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYS7FMS-B T U MIA <br />DISWASHER <br />WALL HEATERS RTU M <br />LAUNDRYTRAY <br />OMIT HEATERS —BTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLE AW IRS <br />METAL FIREPLACE i CHIMNEY <br />$INK ISERVICE—BAR. ETC) <br />SUB TOTAL <br />I <br />SUB <br />TOTAL S <br />PERMIT <br />51 <br />PERMIT <br />S <br />TOTAL FEE <br />51 <br />TOTAL <br />FEE B <br />SIDE YARD SETBACK <br />STREET St TRACK <br />RUB YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />Fit RECEIPT NO. <br />US[ ZONE <br />LOT AREA <br />VACANT 5I7E <br />OYES LINO <br />FSES <br />VALUATION <br />FEE <br />TYPE OF COAST <br />OCCUPANCY GROUP <br />NO OF DWLLLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BIDROOMS <br />FIRE SPRREQUIRED <br />JIFFS PNO <br />MECHANICAL <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 tNVIRORMENTALCH[CK LIST <br />pINAl7Y <br />UBC <br />SEC 10RR) <br />I BUILDING PUNS <br />TOTAL <br />I FIRE HYDRANT <br />A FIRE PROIEC71ON SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADING[ XCAY'ATION 6 CLE ARINGIGRUBBING <br />A DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DI -'.ICE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR TOR ISSUANCE BY <br />9.1-79 <br />