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IAPEL"rew APPLICATION FOR <br />CITY of <br />C..rNSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-0745 <br />EVERETT. WA9B301 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />UdNJ b1Ro5 CoAsT loe_- /:?m //Ertl b.s. /3.-LLFVLIr 97,00 c/ elS'3-S1V/ 5' <br />^^,O•^^•• �^ �+�^ MAIL ADDRESS CITY ZIP PHONE <br />a�,Q{LLG L� 1ARR Assoc. 10b-16r-t'Avr ^JF. Bh•c L,svuP 976C)V V-5's-/rs I <br />TEIIM CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 1 <br />ol� i�Ros Ce,vsY A)C l3/0-//G"`' UF. R.C-L FVLAe- gpooy SYS=-yY/Y <br />PLUMRING CONTRACTOR MAIL ADDRESS C'IY ZIP PHONE LICENSE 1 <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ODEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />5 <br />UFEX�RIIF WORK <br />n '/ <br />PROPOSED USE OF BUILDING <br />OE o • <br />I HEREBY CERTIFY THAT 1 !.AVE 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 9' 9-vo <br />LEGAL DFSCRIPTI OF N:OPOLTV ISHO N BL_ Lovf,oR ATTACH FjDUR coHLsl <br />-7 <br />LOT eLocKLoF <br />l�l <br />loe ADta�s ��,.C. <br />9 v <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 COND UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />_ <br />LAVATORY (WASH BASIN) <br />IBOILERS—HP <br />EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK f DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALL HEATERS—B T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS—B 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 HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- DEVI <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLEADERS <br />METAL FIREPLACE f CHIMNEY <br />SINK (SERVICE -BAR, ETC) <br />SUBTOTAL <br />SUB TOTAL f <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL <br />FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ❑NO <br />►EES <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 />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />I BEDROOMS <br />PRE SPRINKLERS <br />REQUIRED <br />L7YE5 ❑NO <br />MECHANICAL <br />APPROVAL$ <br />BY <br />DATE <br />OTHER <br />T ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC. <br />SEC. LOXII <br />Z BUILDING PLANS <br />7 FIRE HYDRANT <br />TOTAL <br />1 TIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACEI THIS IS YOUR PERMIT <br />5 GRADINGA XCAVATION f CLEAR INCIGPUBRING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />f HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED 6f <br />APPR FOR ISSUANCE BY <br />