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TM ErBrgrRBrl APPLICATION FOR RYBP�„ <br />CITY OF CONSTRUCTION <br />everett PERMIT e <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA9BZD1 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />�OWNI KIAII ADDRESS CIl\ ZIPPHONEPHONE <br />�r: T. 4 �uPc= S, 22 OA,<Fss F'G Pri T /����� 252- 94115 <br />ARCHITECT OR Di SIGNIR MAIL AIIOMSS CITY ZIP PHONE <br />CENTRAL CONTRACTOR .MAIL AIIDRISS CITY !II' PHONE LICENSER <br />AIICHANILAL CONTRACTOR MAR AOORISS CITY ZIP PHONE LICENSE R <br />PLUMPING CONTRACTOR MAIL ADORE $S CITY ZIP PHONE LICENSEE <br />CLASS OF WORK <br />XNEW []ADDITION D7CLTERATION ❑REPAIR ❑DEMOLITION ❑FENCE []SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VMILATION OF WORK <br />S <br />UISLRIHI %YORK <br />1/Vs7illw7,, , i- Tun+,T Tc•:, <br />PROPOSED USI OF OURDIM: <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 OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL OF SCRIPHON OF PRON Fly (SHOWN RI LOW OR ATTACH FOUR COPII a <br />LOT RIOCK_OF <br />�.S 1 �. C '' �- C�✓��LF/ / �,yys y <br />IOH ADDRI SS C' <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET POLL 7) <br />AIR COND UNITS -HP EA <br />BAIHIUB <br />REFRIG[RAIIONUNITS-HP EA <br />LAVA70RY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />CAS FIRED AC UNITS -TONNAGE [A <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-9 T U M EA <br />OISWASHER <br />WALL HEATERS—I1TU M <br />LAUNDRY' TRAY <br />UNIT HEATERS-11IU M <br />CIOTIBS WASHER <br />1VAPORATIVF COOLERS <br />SS'A 11 R HI AT[ R <br />I TOTEMS DRYERS <br />URINAL <br />VI NTILA71ON FAN <br />DRINKING FOUNTAIN <br />RANCE HOOD <br />IFCIOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUIJM BREAKERS <br />STOY'1 <br />ROOT DRAINS—Ei I AD[ ITS <br />SH I AL FIRI PLACE 8 CHIMNEY <br />SINK UERVICI —BAR. E IC ) <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />e c <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET St TRACK <br />RI AR YARD Sl I BACK <br />PLAN CHECK NUMBER <br />PLAN <br />111 <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 CONSI <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF S10RIE5 <br />MAX OCC LOAD <br />PLUMBING <br />TIRE ZONE <br />BASIMENT <br />III DRO^'^, <br />FIRE SPRINKLERS <br />REQUIRED <br />nYFS ONCE <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHICK LIST <br />NAVY <br />URC <br />SIC SEC JBNa) <br />2 BUILDING PLANSPI <br />TOTAL <br />7 TIRE HYDRANT <br />A TIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLYVALIDATE D (IN THIS SPACE)THIS IS YOUR PERMIT <br />5 GRADINOIE XCAVAI IONA CLLARINGIGRUBBING <br />6 DRAINAGE <br />7 IHVIRONMENTAL IMPACT STATEMENT <br />B HIALIH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9-1-79 <br />