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Ful <br />APPLICATION FOR <br />"TYOFft ' .:ONSTRUCTION Re <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 ' • . <br />EVERETT, WA96201 ❑COMBINATION BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />6JII_L..i11Y'Y1 p1.SFJ-=) y191 ORI<ez� !-•Lr-yi'�T 11111) <br />ARCII1l��Z l CT OR DEESIGR 1t A 4RE5 <br />�uK,4LNEj. c� <br />CITY <br />ZIP <br />PHONE <br />i<•i-�.�� QE1�7.�1kUC-1101� ��2G_yl�t.iKl'�. �lJ <br />11i114'CIL)L_d <br />rf{�2_I <br />�-;�r� c'�1`-1°1 <br />CINTRAL CON71 ACTOK MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE I <br />WAC� A�l) QCN 51 ('y Li SCCV 71?C-CI(,lJl 1� LF� <br />114cE<L Arco <br />ae�275 <br />�-clq! <br />Iz31=I•)<H 2Cx.r Y�I;,J <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE F <br />LICENSE <br />PLDM9WG CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />Cl ASS Of WORK��TT <br />❑NEW 5ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VAIUATION Of WORK <br />DESCRIBE WORK <br />Fe-2_'F '6� 1 CilA1 C' <br />et -A) ;ce4 hc1�r111ti1 <br />PROPOSID USE Of B/�LIEDNC <br />m C. \ l�Ti 1'�l �'f - D IE:)1NC <br />' <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 CONTRACTOR ORlfUTMORIZED AGENT DATE <br />DESCRIPTION Of PROPERTY BELOW OR AACH f uR COPIES) <br />LIGAL TT <br />LOT _ BLOCK —OF <br />'sT•E �. Iz a avT F ql� o /.0 j /O R/_I<' -3P,41 <br />' <br />OY w<??�(I DI'+I SIOn q� q�,I� �/HT dE(�dIL:TS JiJ U. `-eCA.Js <br />LOB ADDRESS <br />';3L{ IGI G)4K6-5 <br />PLUMING <br />MECHANICAL\ _ <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND UNITS—H P FA <br />BATHTUB <br />REFRIGERATION UNITS—H P FA <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—BT U M EA <br />DISWASHER <br />WALL HEATERS—B T U 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 FIVE <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLE AW RS <br />METAL FIREPLACL 8 CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />SUE TOTAL <br />SUBTOTAL B <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL <br />FEI <br />SIDE YARD 51 TRACK <br />STREET SETBACK <br />REAR YARD 511 RACK <br />PLAN CHECK NUMBER <br />S� <br />PLAN <br />FIE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />—3 <br />LOT AREA <br />. <br />TLy. <br />VACANT SITE <br />❑YES 00 <br />FEES <br />VALUATION <br />FIE <br />TYPE OF CONST l <br />AJ <br />OCCUPANCY GROUP <br />11�, D <br />NO Of DWFLIING UNITS <br />L/ <br />BUHDING <br />St-�l/f� - <br />SIZE OF PLDG ' <br />)( ZO <br />Np Of STORIES <br />2- <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />_ <br />BASE Mf NT <br />BEIIROOMS <br />IIRl SPRINKLERS <br />RIQUIR <br />EIYL S Ep O <br />MECHANICAL <br />APPROVALS <br />BIT <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SFC BDRRI <br />2 BUILDING PLANS <br />TOTAL <br />_510 <br />S FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRADINGIF%CAVATION 6 CLFARINGIGRUBRING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />6 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />701 <br />9-1 79 <br />