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FM EYBrprBRD APPLICATION FOR <br />CITY OF ..:ONSTRUCTION <br />everett PERMIT <br />DEFT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 ❑COMBINATION BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />ki <br />la a rCV sl$"�.`V00\ <br />A1117HITIC7 j2R 941GNflt h1All ADD SS Cl 11 ZIP PHONE <br />SAIAE, YO SSlK <br />N!�Sui <br />GIN I RAE CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PIL!MBINC. CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE LE <br />CL 45S OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VAIVAHUh Of WORK <br />DESCRIBE WORK <br />Q�(l'.nIAYi9. T1..1�f�AN\1NL0R. YVtxet.Ve Te.� 111.�`i. QA�T�. '� tlsCe. c <br />PROPC,>t0 USE a RUIIDING <br />I HEREBY CERTIN 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 />RITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />A Y OTHER IVE OSTATE R LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED ACE T DATE <br />P <br />x G 27—� <br />LEGAL UI SCRIP71ONOOF PROPERTY (SHOWN BELOW' OR ATTACH FOUR oPllsl <br />LOT �c_c//_ oGK»'� OF ��/>-A G J� <br />•'22p / �` f <br />.J R. �' 3G. ? "� OI / ��C=C-� <br />lux ADDRESS <br />e�z L <br />PLUMBING <br />MECHAPACAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSE T(TOLIET) <br />AIR COND UNITS -HP EA <br />BATHTUB <br />REFRIGERATION UNITS-H P FA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRFD AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />IORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRYTRAY <br />UNIT HLATFRS-BTU M <br />CLOTHES WASHER <br />IVAPORATIVF 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 <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC F <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTALFEE <br />S <br />TOTAL FEE S <br />SIDE YARD St TRACK <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 CNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />BUILDING <br />St".i 71 <br />D <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />111 DRUUAIS <br />TIRE SPRINKLERS <br />REQUIRED <br />?YTS F1N0 <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />i. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UPC <br />SEC 103(a) <br />2 PUILDING PUNS <br />TOTAL <br />f o <br />c% <br />J FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIk XCAVATION A CLEARINGIGRUBIIING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH D15TRICT <br />APPLICATION ACC BY <br />L . c- <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />C-. C-. <br />_l <br />9-1.79 <br />