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IM Evf gmon <br />CITY OF <br />APPLICATION FOP <br />,CONSTRUCTION <br />everett PERMIT <br />C_PT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑COMBINATION <br />MAIL <br />OR <br />❑ BUILDING ❑MECHANICAL <br />❑PLUMBING PERMIT NO. <br />❑rr ZIP <br />PIUMBINGCONTRACIOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />CUSS OF WORK <br />❑NEW ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />YMUALION Of WORK <br />I S��G�� <br />DESCRIBE WORK <br />i f X S <br />PROPOSE Dust OI BUILD IN <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 C014STRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DISCRIPTIqLi OF PROPt RTY (SHOWN RI LOW OR A11ACH FpUIF COPIES, <br />oZ�yoi� Jl/f • <br />LOt _BLOCK 83'5 OF ��"'� fie <br />TOR ADORI SS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (IOLIFT) <br />AIR COND UNITS-H P EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP [A <br />SHOWER <br />CAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL HEATERS -BTU At <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU 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 -RAINLE ADE RS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -OAR. ETC) <br />SUN TOTAL <br />I <br />SUE TOTAL f <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL FFF f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHIC NUMBER <br />PLAN <br />FEE 36 T; <br />CHECK FEE <br />RECEIPT S G NO. <br />USE ZONE <br />LOT ARIA <br />VACANT SITF <br />OYES ONO <br />FFFS <br />VALUATION <br />FEF <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />ril:.,OlT l ct. <br />R <br />NO OF DWELLING UNITS <br />I <br />BUILDING <br />S <br />SIZE OF BLD G <br />IDlil)IfQ -.(o $,j= <br />NO OF STORIES <br />I <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />`- <br />BASEMENT <br />-- <br />NI UROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES Fka <br />MICHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC. <br />SEC TORa) <br />Z BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />a FIRE PROTECTION SYSTEM <br />5 GRADING4 XCAVAT ION& CL E ARINGIG RUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED UN THIS SPACEI THIS IS YOUR PERMIT <br />6 DRAINAGE <br />1 ENVIRONMENTAL IMPACT STATEMENT <br />6 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />L.{1. 1� <br />APPR FOR tSSUANCE BY <br />9-1-79 <br />