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Cl" EW„T/BR APPLICATION FOR r EHRnRR <br />OF <br />C.JNSTRUCTION e <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2S9-0745 <br />EVERETT, WA 9B2D1 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. _ <br />OWNER MAIL ADDRIIS CITY 21P PHONE <br />tL,f <br />NUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS Of WORK <br />❑NEW ❑ADDII ION ❑ALTERATION ❑REPAIR EMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION <br />DISCRI6E WORK <br />own sm uU DF RUHDINc <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 D RIPIIONOFPROPERTYISHOW Low Opt ATTACH F URCOPIES <br />/p A � <br />LOT �BL«KoI S(.A-s' <br />• <br />TOP ADDRI SS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR CONE) UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK 6 DISP <br />FORCED AIR SYSTEMS-B T.0 M EA <br />DISWASHER <br />WALL HEAL ERS-B.TU M <br />LAUNDRY 7RAY <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-RAINLEADEKS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE -BAR, ETC I <br />SUB TOTAL <br />SUB TOTAL B <br />PERMIT <br />S <br />PERMIT B <br />TOTAL FEE <br />R <br />TOTAL <br />FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO, <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <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 />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ONCE <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECKLIST <br />PENALTY <br />U.BC. <br />SFC. )07(R) <br />7 BLEEDING PLANS <br />TOTAL <br />) FIRE HYDRANT <br />/. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />) GRADING/E %CAVATIONBCIE AKINCIC.RUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />S. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9-1-79 <br />