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APDLICATION FOK <br />ICITY OF IBREF !Y <br />CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-E715 <br />EVERETT. WA"201 ❑COMBINATION ❑ BUILDING ®MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER' MAII ADOMF SS CITY <J ZIP I PHONE <br />( (Ze s s 20 "31 r Cr y/oZ§-2 G ?'j 2 <br />ITY ZII PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE <br />50. <br />COY LIP PHONE <br />LICENSE 1 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE IF <br />NUMBING CONTRACTOR <br />MAIL ADDRESS <br />CLASS OF WORK <br />❑NEW []ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />DESCRIBE WORK T ll n L n -L- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE OF BUIIOING <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />IECAL DESCRIPTION Of PROPERTY ISHOWN BELOW OR ATTACH FOUR <br />COPIES) <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT _BLOCK _Of <br />GIVE AUTHOR!TY 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 C TRACTOR OR ALIT ORIZED AGENT DATE C� <br />JOB ADDRESS <br />2031 1r N,GC <br />X <br />MECHANICAL <br />PLUMBING <br />_ <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />WATER CLOSET (TOLIET) <br />AIR COND UNITS—H.P. EA <br />REFRIGERATION UNITS—H P. EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />GAS FIRED A C UNITS —TONNAGE EA <br />SHOWER <br />FOR AIR SYSTEMS—B.T.0 M EA <br />KITCHEN SINK 6 DISP <br />WALL HEATERS-8 TV M <br />DISWASHER <br />UNIT HEATERS-9 T U. BollCLOTHES <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />WASHER <br />WATER HEATER <br />CLOTHES DRYERS <br />VENTILATION FAN <br />URINAL <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 6 CHIMNEY <br />SINK (SERVICE -BAR. ETC) <br />SUBTOTAL { <br />SUBTOTAL <br />P[tMIT S <br />PERMIT <br />{ <br />TOTAL FEE <br />{ <br />TOTAL <br />FEE { <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK EE <br />FEE <br />RECEIPTNO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />ml ZONE <br />BASE MFNT <br />BEDROOMS <br />FIRE SPFIUKLERSREQ <br />MECHANICAL <br />17 <br />OYES ]No <br />APPROVALS <br />of <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECKLIST <br />PENALTY <br />SEC M/MR1 U.BC. <br />TOTAL <br />2 BUILDING PLANS <br />5 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGII XCAVATION 6 CLEARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />{. HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPK FOR ISSUANCE BY <br />5 <br />941 79 <br />