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APLICATION FOR <br />G OFLiNSTRVCTION <br />everett PERMIT - <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA96201 ❑COMBINATION ❑ BUILDING <br />MAIL ADDRISS <br />ARCHIIECT OR DE51611R MAIL ADDRESS <br />se1M L" <br />,MECHANICAL ❑NUMBING PERMIT NO. <br />�.. C1IY 21P PHONE 1 <br />CITY ZIP PHONE <br />w <br />GENERAL CONTRACTOR MAIL ADDRESS CITY UP <br />r 4/Ir I:� <br />,EC MA 1 CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />LIP <br />PHONE <br />LICENSE E <br />PLUMBING CONiRAC10R <br />MAR ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />l 4Cl4 S OF WORK <br />ClNEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />E <br />Ul RISE WORK I F l <br />W iay+�ar1 A r' YrI T C7.7 1 "J'r'�� �J�+"' %Cc�11�r1N�• <br />�bc�`r In1ny S`�o vc � <br />POSED USE OF BUILDING <br />Ten.co fy4ja 1 <br />BE <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN LOW OR ATTACH FOUR COPIES) <br />LOT BLOCK _OF <br />1 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 />(so P / <br />'�;T525 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE Of EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND UNIT$-H P EA <br />BATHTUB <br />REFRIGERATION UNITS-N.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK S DISP <br />FORCED AIR SYSTEMS -BTU M EA <br />DISWASHER <br />WAIAHEATERS-BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-8 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- C F M <br />VACUUM BREAKERS <br />STOVE 00 <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC 1 <br />SUB TOTAL <br />' <br />SUBTOTAL B <br />PERMIT <br />51 <br />PESMIT i <br />TOTAL LEE <br />51 <br />TOTAL <br />FR B <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 ONO <br />FEES <br />VALUATION <br />RE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO. OF STORK <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YFS ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U BC. <br />SEC TOX81 <br />2 BUILDING PLANS <br />TOTAL <br />FIRE HYDRANT <br />1 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGILXCAVATION 6 CLEARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />V.G <br />9-1 79 <br />Y <br />