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IRA ELw"w <br />CITY OF <br />APPLICATION FOR <br />everett CvNERMITTION <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />Ow MAII ADDKf SS CITY ZIP PHONE <br />(�erN (3RoS CoATsT /I G cl.svLie 97106 L/ yS3 5pV/ V <br />ARCHITECT OR DISIGNIN MAIL ADDRESS CITY ZIP PHONE <br />EC AJ, vac Lc DARR Assoc. K/06-/a PAN fi uc- /UF. B&L L,evur 970 clI/ <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 1 <br />�oli; a ,OS CBATai /AJC l3/d-//G_`' U�• (3L«Evur ygool/ `{S�' y5/Y <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />01 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Cl ASS Of WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />DESCRIBE WORK <br />PROPOSED USE OF FLU II DI NG <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 />LEGAL DISCRIPTItRJOEIPROPERTY ISHOWN BELO%%OK ATTACH F <br />,E }� <br />LOT BLOCK `) of <br />R coNIS) <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 />loe ADDRESS G,f.E.d. <br />X <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND UNITS -HP EA <br />WATER CLOSET (TOLIET) <br />REFRIGERATION UNITS -HP EA <br />BATHTUB <br />BOILERS -HP EA <br />LAVATORY (WASH BASIN) <br />GAS FIRED A C UNITS -TONNAGE EA <br />SHOWER <br />KITCHEN SINK { DISP <br />FORCED AIR SYSTEMS-8 T U M EA <br />WALL HEATERS-8.TU M <br />DISWASHER <br />LAUNDRY TRAY <br />UNIT HEATERS-8 T U M <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />-. <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />- <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M. <br />j. <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE { CHIMNEY <br />ROOF DRAINS-RAINLEADERS <br />-. <br />SINK(SERVICE -BAR. ETC; <br />SUS TOTAL <br />SU{ TOTAL { <br />PERMIT { <br />PERMIT { <br />- <br />TOTAL Fit <br />IT <br />TOTAL <br />FEE { <br />SIDE YARD SETBACK STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE LOT AREA <br />VACANT SITE <br />OYES ONO <br />TEEf <br />VALUATION <br />fit <br />TYPE OF CONST OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />f <br />SIZE OF BLDG NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE BASEMENT BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />OYES ONO <br />OTHER <br />APPROVALS By DATE <br />1. ENVIRONMENTAL CHECKLIST <br />PENALTY <br />Lac <br />SEC. NO3(K) <br />] BUILDING PLANS <br />S FIRE HYDRANT <br />TOTAL <br />■ <br />7 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />R. FIRE PROTECTION SYSTEM <br />S GRAOINGIEXCAVATION{ CLEARINOCRUBBING <br />{ DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />{ HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9 1-79 <br />