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APPLICATION FOR �.RPEEE <br />CITEOF DP CITY C%jNSTRUCTION e <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-874S <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OW N[R MAIL ADDR155 CITY ZIP NIONE <br />1/r;/ F' FO4K� e /3,06 /4& NL 13 9�ooY YS —9y/y <br />ARCHITECT OR DESIGNER MAIL AD/M�E55 CITY ZIP PHONE <br />._1 /_ Nn i/+anx. •%nn-/AT-`LA-r <br />GENERAL CO-NTR/ACTOR ,C MAIL ADDRESS CITY {� 21P PHONE LICENSE <br />��A..-f. iw-E lT4w-�•^*<-pi-s�- 7� I•]�%0 -//4ZE` /51 IJ•-til Y ' `/S3 9'1� `i <br />CITY ZIP PHONE LICENSE / <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />CLASS Of WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR AEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />S <br />IIISQIBE WORK <br />r 0 L. N <br />PRo s[DUS[ OF BUILDING <br />LEGAL OLdInIP11ON OF PROPERTY ISHO'N LOW OR ATTACH I UR COPIES <br />� ..[� <br />Lol ��BLOC K M OF SL.�-A' <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 WHETF.ER 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 ///Dfff--ATE <br />q—F O <br />X 91/LOB <br />AOdIESS <br />PLUM!)ING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIETI <br />AIR COND UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS -HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK B DISP <br />FORCED AIR SYSTEMS-B.T U. M EA <br />DISWASHER <br />WALL HEATERS-B.T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS-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 -RAINLEADE RS <br />METAL FIREPLACE L CHIMNEY <br />SINK (SERVICE -BAR, ETC I <br />SUBTOTAL <br />SUBTOTAL / <br />PERMIT <br />/ <br />PERMIT / <br />TOTALFEE <br />I <br />TOTAL <br />FEI I <br />SIDE YARD SETBACK <br />STREET 5ETRACK <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 ONO <br />t[Ff <br />VALUATION <br />FE! <br />TYPE OF CONST <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 BL DROOMS <br />MAX OCC LOAD <br />DNKLf RS <br />FIRE REQUIRED <br />DYES ONO <br />PLUMBING <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />T ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.EC <br />SIC 703111 <br />_ <br />7 ]UILDING PLANS <br />TOTAL <br />FIRE HYDRANT <br />1 FIRE PROTECTION SYSTEM <br />5 GRADINGIEXCAVATION B CLEARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT <br />f DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />