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FM EwFIyRRn AP. i I CATION FOR <br />CITY OF CONSTRUCTION e <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HAII 259-8745 <br />FVERFTT. WA 98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNIR MAIL AUORI%S O11 lip PHONE <br />U*APobi CoNkcaprf- 36019 ptii h-pr <br />ARCHITECT OR OISICYR MAIL ADDRIU fill ZIP PHONE <br />CENTRAL CONTRAC FOR MAII AII0RISI (IT\ ZIP PHONE LICENSE <br />_s1Mc0 S4#jawp.. %III M.Aft 'ter 9eo 04 ZSs.-06Y, SI-Mt-6 cL1t�P3 <br />AICHANICM CONTRACTOR MAIL ADORISS LI11 ZIP PHONE LICFN FS <br />CONTRACTOR MAIL ADDRI IS (ITS ZIP PHONE LICENSEI <br />(r AAA OI "ORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE Sie"IGN ❑GARAGE 116UILDING RELOCATION <br />� Art An(1. Or wo K <br />OI ACNHH A1YUNA <br />�f@F 41w ^tI. U44, <br />PRI mu.IDI SI Of fit ROrvC <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 (ONT C1 OR AUTHORIZED AGENT DATE <br />x / I " d <br />ICAI HEb(RIPIION(1I PROPIRTY ISHOWN RHO%% OR AIIM O FOUR COPIES) <br />IOl •—RIOCA—CIF <br />- <br />TOR MIURIK <br />=r/mil fiiU� `� <br />PLUMBING <br />MOnANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET I TOIB T) <br />AIR COND UNHS-HP EA <br />BATHTUB <br />REFRIGERAIMNUNITS—HP IA <br />I AVATORT ESA ASH BASIN) <br />BOILERS —HP EA <br />SIIOSSIR <br />CAS FIRED AC UNITS —TONNAGE LA <br />KITCHI N SINK A DISP <br />FORCED AIR SYSTEMS —BTU M EA <br />OISWASHIR <br />WALL HEATERS—B I U M <br />LAUNDRSTRAY <br />UNIT HE ATTRS—BTU %I <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HIATIR <br />CLOTHES ORY[RS <br />URINAL <br />VENTILATION AN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINL(ADE ITS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK ISFRVICI -BAR, ITC 1 <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDI YARD SI 113 ICE <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SHE <br />DYES CNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />0 <br />� <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC TOAD <br />PLUMBING <br />FIRE ZONE <br />BASFMF NT <br />III UROOM% <br />FIRE SPRINKLERS <br />RLQUIRED <br />ETYFS DNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC ]co(a) <br />2 BUILDING PLANS <br />TOTAL <br />S FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />S GRADINC.II %CAVATIONB CLIARINWGRUNBING <br />PERMIT VALIDATION <br />WHEN PROPERLY V)/ALLIDATED( THISSPACE) THIS IS YOUR PERMIT <br />7 -lq`wLIx1f <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CIHECKE9 BY <br />'Fir <br />�7 <br />A <br />APPR 10 y/ISSUANC BY <br />91 79 <br />