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kM EYfrgrfmn A,"LICATION FOR -- <br />CITY OF WNSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑COMBINATION ❑ BUILDING XMEC <br />Ly �NFR In MAIL ADDRESS <br />IV�r15 �• ��c'nUszsh �O�?r <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />L ❑PLUMBING PERMIT NO. <br />ZIP <br />P(, _i~ yr •F.•ef{` �� � i : J�' 3 5? 53g <br />ZIP <br />CENIAAICONTI�AIOR <br />MAIL ADDRESS <br />Un <br />ur rmsno uunaa• <br />MECCHA IC.N1 L TRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE 1 <br />ClA SOf WORK <br />NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />y <br />VAIVA ION OF WOR <br />F 11 ply <br />WORk Dk RIBF l <br />' 4 \l Y, )N �u�ln\Yy .S-_(oyc eYl'^�rl Arvy\ /t 4':err' �� �i"i' CLA1g,Elwy <br />^°sED USE OF BUILDING <br />�e,5� f Vrll�2 I <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 CONTRACTOR OR AUTHORIZED AGENT DATE <br />woll -.ham, r r <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OA ATTACH FOUR COPIES) <br />LOT BLOCK_OF <br />'4`20 55 Pe <br />k PL <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIET) <br />AIR COND UNITS—H P EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P EA <br />LAVATORY (WASH BASIN) <br />BOILERS—H P EA <br />SHOWER <br />GAS FIRED A C 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 WASH!R <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 OO <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE —BAR. ETC.) <br />SUB TOTAL <br />' <br />SUB TOTAL f <br />PElMIT <br />S <br />PERMIT f <br />TOTAL FFE <br />5 <br />TOTAL <br />FEE f <br />SIDE YARD SETBACK <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 SITE <br />OYES ONO <br />FEES <br />VALUATION <br />►E! <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 />Hk DRIX)MS <br />FIRE SPRINKLERS <br />❑YES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U BC. <br />SfC 10R�1 <br />2 BUILDING PLANS <br />TOTAL <br />] FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRADINGIEXCAVATIONACLEARINOGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR fOR ISSU. NCF BY <br />�I <br />