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the Ewrgrwn AP. 11CATION FOR <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA982o1 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNIR N/JI kt)PRIx Tl lip PHONE <br />u*Afta act 40NICOPTLs 3G19 :FLme evr <br />ARCH I I I C I OR IT NI GNI R MAIL ADDRESS Ili, 71P PHONE <br />GINIRM CONIRM TOR MAII ADDRI SS I Ill I'll, PHONI LICENSE <br />fo%wo SI%•/a%w. %I1g E.-r ZSs.-ooy. Im-mc-os e-lat _ <br />( ITT <br />PIPMLINC CONIRACIOR MAIL ADDRI SS (III 71P <br />t I ks%(11 SIORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE. *IIGN ❑GARAGE ❑BUILDING RELOCATION <br />V III AII� N(� <br />O <br />I1111RI111 \S ORI. <br />?05L AK&WAO kL6kL—1WoU44 � <br />PROPOMD(M 01 BOIL DIY(. <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 />NICVNAIURI OF CON 7#i OR AUTI10R17.ED AGENT DATE <br />n(,M IIISCRINION OI PROPIRT) IMIOI%N BIION OR ATTAC9 TOUR COPBNI <br />IOI —MOCK —of <br />• <br />PLUMBING <br />WAIKANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />%Ali R( EOM 11101 It 11 <br />AIR COND UNITS -III' IA <br />BAIHTUB <br />REIRIGERATIONUNITS-HI' IA <br />IAVAJOR11WASH 11MIN1 <br />BOILERS -HP EA <br />SIION I R <br />GAS FIRED A C UNITS-IONNAGE EA <br />WOLI N ,INK A DINT' <br />IORCE D AIR SYSTEAIS-BTU M LA <br />OISSVASHER <br />WALL HEATERS-B T U M <br />LAUNDMIRAY <br />UNIT HLATIRS-BTU h1 <br />(1011ll S %%ASHE R <br />L VAPORATIVE COOLERS <br />WATER HLAIER <br />CIOTIIIS DRYERS <br />URINAL <br />VINDLAIION FAN <br />DRINKING fOUNTAIN <br />RANGE HOOD <br />I COR DRAIN <br />AIR HANDLING UNIT- CFht <br />VACUUM BREAKERS <br />SIOVF <br />ROOF DRAINS - RAINLIADIRS <br />METAL IIRIPLACI &CHIMNEY <br />SINK SERVICE -BAR, ETC 1 <br />SUBTOTAL <br />SUB TOTAL F <br />PERMIT <br />3 <br />PERMIT B <br />TOTAL FEE <br />s <br />TOTAL FEE IF <br />SIDE YARD St TIIACK <br />SiR tl SETBACK <br />RI AR YARD SI WALK <br />PLAN CHICK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />IEEE <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />J 0 <br />r <br />SIZF OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />E11 DROOVIS <br />FIRE SPRREQUIRED <br />ETYTS ETNO <br />Mf CHANICAI <br />hit <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U BC <br />SEC 301(a) <br />1 BUILDING PLANS <br />TOTAL <br />L TIRE HYDRANT <br />I FIRf PROTECTION SYSTEM <br />S GRADING4 XCAVAT ION& CIE ARINGIGRUBBING <br />PERMIT VALIDATION <br />YVHEN PROPERLY VALIDATED(>jl THIS SPACH THIS IS 1OUR PERMIT <br />/�� �•1t� <br />���_ <br />L DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKKEE99BBY <br />ICC��iY� <br />APPR/FO y/LySSgU1ANC BY <br />�l f IVV <br />