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[8R EWMmn <br />CITY OR <br />APPLICATION FOP <br />everett �ONPERMITTION <br />DEPT OF COMMUNITY DEVELOPMCNT SERVICES <br />CITY HALL 259-874S <br />EVERETT,WA98201 ❑COMBINATION <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />717a pia LC�C ��90'Y ., /.7ell -)(,ITTDR✓_ ty_-P1-77 %A n 3 3e`.3-4 777— <br />ARCHITECT OR OISICNIR MAIL ADDLEI SS CITY ZIP PHONE <br />CE/NNIR{A`J [ONLM[TOR M)AIL AUpR[SS CET` ZIP PHONE [IC[NSF 1 <br />�l/!'Zytt/F Y✓C-V� .0 7w <br />CITY ZIP <br />PIL.FUNG CONTRACTOR MAIL ADDRESS CITY ZIP PHONE IICENSEI <br />CLASS OF WORK <br />❑NEW 1AADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />(\'AIUATIONgqO��f��'M�'OR�k <br />DESCRIBE WORA <br />�L_FtifNRG� G-HR/ . " <br />PROPOSED USE Of BUILDING <br />IF : Tc c- -' <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 1 HE PERFORMANCE OF CONSTRUCTION, <br />SIGNATURE Of CONTRACTOR OR AUTHORIZED AGENT DATE <br />X. . C1 1 c, /S 4 <br />LEGAL DESCRIPTION OF PROPIRTYISHOMN B(IOSS'OR ATTACH FOUR COPIES) <br />LOT 1ZBLOCK OF rU ' P <br />F- O-et S /Sc ;- ,F-& - 44 7 7- <br />JOB ADDRESS <br />17ci c-i= i7F . = f_ , - <br />PLUMBING <br />I),I <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 UNITS -HP EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H P EA <br />SHOWER <br />CAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CIOTHFS 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 <br />ROOF DRAINS -RAINLF AD[ IRS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC <br />SUBTOTAL <br />SUB TOTAL B <br />PERMIT <br />S <br />PERMIT B <br />TOTAL FFE <br />S <br />TOTAL FEE B <br />SIDE YARD 511 BACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE /D3 <br />�j <br />CHECK FEE <br />RECEIPT NO <br />S/ <br />USE ZONE <br />LOT AREA <br />��[ ( <br />VACANT 511E <br />❑YES �NO <br />FEES <br />VALUATION <br />FEE <br />TYPE T <br />�k) <br />OCCUPANCY GROUP <br />IL-1 `— I <br />NO OF DWELLING UNITS <br />I <br />BUILDING <br />Sc !1/fY CC) <br />SIZE OF BLDG /N <br />a6�6Zk �g'�6 <br />NO OF STORIES <br />II <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />OASFMENT <br />111 DROOMS <br />�^ <br />FIRE SPRINKLERS <br />REQUIRE <br />FITTS O <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTTER <br />i ENVIRONMENTAL CHECK LIST <br />PlNAL TY <br />::4 <br />U BC <br />SEC ]OXA) <br />2 BUILDING PLANS <br />TOTAL <br />32 <br />J FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRADING❑ XCAVATION & CIE YRINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IM ACT STAT[MENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />1 c. <br />APPR FOR ISSUANCE BY <br />Ac. <br />7 <br />91-79 <br />