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„,w, APALICATION FOR <br />everett CJNPERMITTION Pi <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 25"745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ®MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN[ R r r n MAIL ADDRESS CITrry ZIP PHONE <br />T-A, y �• Q. 2031 RA;h,tr GJ. ff8201 Z§-z G?3Z <br />ARCHITECT OR DESICNIR I MAIL ADORE 55 CITY ZIP PHONE <br />GIMBAL CONTRACTOR <br />MAIL ADDRESS <br />City <br />ZIP <br />PHONE <br />LICENSE B <br />5� <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE L <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />CLASS OF WORK <br />❑NEW ❑AUDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ]FENCE ❑SIGN ❑GARAGE ❑BUIIDING RELOCATION <br />VALUATION OF WORK <br />DESCRIBE WORK / /1 <br />LK.r*t1( 4r.. i'TRSrCXiIAY AIr '�qi+\ VJodL $`iDU� <br />PROPOSED USE OF BUILDING <br />LEGAL DISCRIP110N Of PROPERTY ISFOWN BELOW OR ATTACH FOUR COPIES) <br />LOT --BLOCK_ OF �. <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 />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/COTTRACTOR OR AUT ORIZED AGENT DATE <br />/ _ /V _ t'JVQ <br />X <br />—' <br />101 ADDRESS <br />Ave- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TV” OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-h '. FA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK B OISP <br />FORCED AIR SYSTEMS—B.T U M EA <br />DISWASHER <br />WALL HEATERS—B.TU M <br />LAUNDRY TRAY <br />UNIT HE ATERS—B 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 <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE L CHIMNEY <br />FT <br />SINK (SERVICE —BAR, ETC) <br />SUBTOTAL <br />SUBTOTAL B <br />_ <br />PERMIT <br />S <br />PERMIT S <br />TOTAL ►EE <br />S. <br />TOTAL <br />FEE S <br />SIDE YARD SETBACK <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 />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF COAST <br />'OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />FIRE ZONE <br />NO Of STORIES <br />BASEMENT BIOROOMS <br />MAX OCC LOAD <br />FIRE SPRREQUIRED <br />DYES ONO <br />PLJMBING <br />MECHANICAL <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />T ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U.BC. <br />SEC 70XR) <br />7. BUILDING PLANS <br />TOTAL <br />TIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRAOINGIIXCAVATION&CLLARINUGRUBBINC <br />_ <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />B DRAINAGE <br />_ <br />7. ENVIRONMENTAL IMPACT STATLMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC DY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />