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MB EwrprBBn <br />CITY OF <br />APPLICATION FOR <br />CONS TRUC TIOE . <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />4.OWNER MAIL ADDRESS CI7T ZIP PHONE <br />IA8A70 Noc,LsclJ a/io R4m,er Zeeretf- °J�so/ 251- <br />ARCHITECT OR DESIGNER MAIL ADORE CITY ZIP PHONE <br />(d <br />eYerelt <br />e <br />PLUMBING CONTRACTOR MAIL ADDRLSS CITY ZIP PHONE LICENSEE <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE (]BUILDING RELOCATION <br />VALUAtIO%OT WORK <br />7e 1 I.26 . I" <br />DESCRIBE 1WORK <br />Kdm./J �OY Ll.lw�l LAtboe[� .LtPrSc/) <br />PROPOSID USE 91 BUILDING <br />1 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 CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOWOR tT cH l0ua coensl <br />..(E pp 'l,,, / <br />L07 J 9 DIOCK T 7/ OF <br />_--1 <br />IOB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATT CLOSE (COLIC II <br />AIR COND UNITS—H P EA <br />BATHTUB <br />RE FRIGERAtION UNITS —HP EA <br />LAVATORY (WASH BASIN) <br />R01LERS—II P EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE U <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-0 T U A7 FA <br />DISWASHER <br />WALL HFATFRS—B T U AA <br />LAUNDRY' TRAY <br />UNIT HEATERS —BTU Al <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />%%'ATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILA71ON FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C 1 M <br />VACUUM BREAKERS <br />$LOVE <br />_ <br />ROOF DRAINS-RAINLE AD[RS <br />METNL FIRIPLACI A CHIMNEY <br />SINK ISERVICE—BAR. ETC 1 <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />3 <br />•ERMIT S <br />TOTAL FIE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREFI SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FIE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES NO <br />FEES <br />VALUATION <br />FEE <br />STY/PET OF CONST <br />Jr_0 W0ow <br />OCCUPANCY GROUP <br />I <br />NO OF DWELLING UNITS <br />/ <br />BUILDING <br />S <br />SIZE OF BLDG <br />----- <br />NO OF STORIES <br />R.�MF P <br />MAX OCC LOAD <br />----- <br />PLUMBING <br />FIRE ZONE <br />HASEMFNT <br />III GROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />C1Yf5 (?% <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PINAI. TI <br />LI HC <br />SIC 1BTIn1 <br />2 BUILDING PLANS <br />TOTAL <br />T FIRE HYDRANT <br />1 FIRE PROTECTION SYSTEM <br />5 GRADINGIIXCAVATIONLCLIARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IIN THIS SPACE)THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />R HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />I l <br />APPR FOR ISSUANCE BY <br />91 79 <br />k <br />