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APIOICATION FOR !Yl1BB <br />cm OF CONSTRUCTION e <br />everett PERMIT <br />DEPT. Of COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 25"745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER �/�1 MAIL ADDMI SS CITY 21P PHONE <br />�P%redkl ��1� �i�ir✓INR .✓�s-��� 9¢2e/ <br />ARINITIrT ORM WHIR MAIL ADDRESS CITY ZIP PHONE <br />ZIP <br />4INtRAI LIII'IlRAl1U'yR �Z mm. nvv�•�• r,,�, U r �/ <br />/x-.. /1 o /// 'I 2• C� ~i Y�' .J1%[rIYL) �is1 C V 16.Z l y a 5 7 /�/ e^ f'�l <br />MICHANICAI CONTRACTOR U MAIL <br />PI VWPINC CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE R <br />L I ASN III WORK �� <br />❑NEW ❑ADDITION L:J ALTERATION ]REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />\AIUAl1(b'jlf�0� <br />S QQQyJJ <br />DI NC RIM WORK <br />Ae =e & .J <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PROPOII,I of Ron N/c <br />�� , <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />TYPE <br />d��y <br />0 �2 <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />III:AI DI SCRIP1N OF PROP( MY (SHOWN pflOW OR AIIACII FOUR <br />10 <br />COPIES) <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OF W <br />\ L�p «K O d42F� pj <br />✓ �� <br />OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT <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 />L <br />SIGNATURE OF CON/,TRACTOR OR AUTHORIZED AGENT/ DATE ) <br />' (J� 1 2E. <br />It IH ADDRI to <br />v , <br />i` •f.J mil' T <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE Of FIXTURE <br />FEE <br />NO. TYPE OF EQUIPMENT <br />AIR COND UNIT$ —HP fA <br />�- <br />W'AIIR CLOSET(TOILET) <br />RffRIGIRA710NUN1T$—MP (A <br />�- <br />BATHTUB <br />dU1LF RS—HP IA <br />I MUIORI (WASH BASIN) <br />GAS FIRED AC UNITS—IONNAGf EA <br />SHOWER <br />IORCID AIR $YS7[MS-13TU AT EA <br />KITCHEN SINK A DISP <br />\1'All MI AIf R$—B1 U M <br />DISWASHER <br />UNIT MI AiI RS—NTU M <br />LAUNDRS IRA( <br />I \'APURA7IVI COOlf 0.5 <br />CIUTHIS WASHER <br />CLOTHIS ORYERS <br />WATER HE ATf R <br />\q NIIIAIION TAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANOUNG UNIT— C F M <br />FLOOR GRAIN <br />VACUUM BREAKERS <br />S IIri'I <br />nFI 7Al 11R1 PL ACE A CHIMNEY <br />ROOF DRAINS — RAINLI AIDE RS <br />SINK (SF RVIC1 —BAR ( IC I <br />SUBTOTAL <br />S <br />SUB TOTAL <br />PERMIT IF <br />► <br />IS <br />TOTAL FEE B <br />TOTAL FEE <br />ISPLAN <br />PLAN CHICK NUMNIN CHECK FEE <br />SiRIfi SI LflACK <br />REAR SARD 51 iIlACK <br />510E SVPD SI (PACK <br />FEE RtEfIPT NO <br />USE LONE <br />TOE AREA <br />VACANT SI71 <br />FEES <br />VALUATION <br />FEE <br />OYES CNO <br />TYPE Of CONS( <br />OCCUPAN0 GROUP <br />NO Of DWI 11INC. UNITS <br />HOLDING <br />S L <br />SILT OF NlOG <br />NO Of STORIES <br />MAX O(C FOAO <br />rLunnuuc <br />FIRE ZONE <br />BASEMENT <br />HIDR)IMIS <br />TIRE SRfOKILRSREQUI <br />MI QIANIL At <br />IlY1S ONO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHICK LIST <br />PENAL IS <br />URC <br />SEC 10%+) <br />2 BUILDING PLANS <br />TOTAL <br />Ell <br />I FIRE HYDRANT <br />A FIRE PROTECTION SISIfM <br />PERMIT VALIDATION <br />WHIN PRO"I REY VAUDAIEIS(IN THIS SPACE(TM1515 YOUR PERMIT <br />S GRADINGE FIE. AVAIION A CL I ARINGICRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BYPAPPRFOR <br />ISSUANCE RY <br />9-1 79 <br />