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the EvfrgrffA <br />CITY OF <br />APPLICATION FOR- <br />�:ONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT.WA98201 ❑COMBINATION <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />-3 <br />ARCHITECT OR DISIGNIR MAIL ADDRESS CITY ZIP PHONE <br />evereIt <br />Le <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE F <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY LIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSEI <br />CLASS OF WORK <br />❑NEW ❑ADDITION <br />❑ALTERATION 2REPAIR <br />❑DEMOLITION ❑FENCE ❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />I ALUMION OF WORK <br />DESCRIBE WORK <br />Paoroslousr or B nDINc 1% <br />;dC K _ :' <br />LI L DISCRI 4OF PROPERTY(SHOWN ILOW'OR AI TA N FOUR COPIES) <br />7 <br />Lolz.L ' BLOCK-.UOF _ <br />I HEREBY CERTIFY THAT 1 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 />TOR 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 ITOLIET) <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRICERATION UNITS—H. P. EA <br />LAVATORY IWASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />CAS FIRE D A C UNITS —TONNAGE EA <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />DISWASHIR <br />WALL HEATERS —BTU 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— CFM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLE ACT ITS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR. ETC 1 <br />SUN TOTAL <br />SUN TOTAL f <br />PERMIT <br />IF <br />PERMIT • <br />TOTALFEE <br />f <br />TOTAL <br />FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <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 />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />OQ <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />ILL DNDDMS <br />FIRE Iq FIDNKLERS <br />YE5 ❑NO <br />MECHANICAREQL <br />APPROVALS <br />NY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />_ <br />U.BC. <br />SEC 3oxa) <br />Z BUILDING PLANS <br />TOTAL <br />o <br />QO <br />B FIRE HYDRANT <br />4 FIRE PROTECTIONSYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />S GRADING)) XCAVAT ION& CLEARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />6 HEALTH DISTRICT <br />APPLICA71177ACC BY <br />PLAN$ CHECKED BY <br />APP0. FOR ISSUANCE BY <br />9 1-79 <br />