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P PPLICATION FOP <br />th <br />e <br />OF CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 OCOMBINATION ❑ BUILDING <br />C OWNER MAIL AllsCoti 4' Geo.c� Le S F I ✓e LA;ooOL /9? 7 <br />❑MECHANICAL ❑PLUMBING PERMIT NO. <br />l llA /II' PHONE <br />evereft <br />e <br />ARCHITECT OR DESIGNER MAIL ADDRESS CI II /II' 1'1.UNt <br />GIMBAL CONTRACTOR MAIL ADDRESS 111) ZIP PHONE LICENSE <br />MECHANICAL <br />CONTRACTOR MAIL ADDRESS ID ZIP PHONE LICENSE p ..I <br />,§a*- / V <br />PLUMBING CONTRACTOR MAIL ADDRESS UI\ ZIP PHONE LICENSE AT <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE El BUILDING RELOCATION <br />VALUATION Of WORK <br />3 <br />DESCP. BE WORK <br />wlJ eto 3 6vc_ <br />PROPOSED USE OF BUILDING <br />�%L.\ sJ • <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 />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OF <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 />X a_ <br />IEGAl DESCRIPTION Oi PpOP[Riv (SHOWN BELOW OR ATTACH {OUR COPIES) <br />LOT BLOCK_Of <br />i8a7 <br />PLUMBING <br />MEC ANICAI <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />SVA7ER CTOSL7 I EOUTII <br />AIR COND UNITS -HP LA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIPED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS -BA U M EA <br />D15WASHIR <br />\VALE HEATERS-B T U M <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU 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- CFM <br />VACUUM BREAKERS <br />X <br />STOVE <br />ROOF DRAINS-RAINLE ADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC 1 <br />SUB TOTAL <br />SUBTOTAL 3 <br />PERMIT <br />3 <br />PERMIT 3 <br />— <br />TOT AI FEE <br />3 <br />TOTAL FEE 3 <br />SiOE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />TIE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ❑NO <br />FEES <br />VALUATION <br />FLI. <br />TYPE OF CONSI <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG <br />q0. OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />Bk DROOMS <br />FIRE SP REQUIRED KLERS <br />MYES ONO <br />MECHANICAL <br />OTHER <br />APPROVALS <br />BY <br />DATE <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />L If . <br />104'1 <br />2. BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />YHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />5 GRADINGIEXCAVATIONACLEARINGIGRUBBING <br />h DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEMTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISMIANL 1 10 <br />9-1.79 <br />