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A LIGATION FOR <br />AMNSTRUCT10N <br />everett PERMIT <br />DI: PT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAILADDRESS CITY ZIP PHONI <br />A"d%°L, F NaAi P/5 4rvrl7Yr7 98sob �J� J Zi <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICINSF <br />MI CHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PI UMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />CLASS OF WORK <br />❑NEW ❑ADDITION []ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE 013UILDINGRE-OCATION <br />VALUATION OF WORK <br />3,f'v <br />DESCRIBE WORK <br />y <br />PROPOSED USE OF BUILDING <br />41 <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 />I IGA/LDESf;RVPTIONOt PPROOPPIRTY (SH 'N BLLON'OR ATTA�O71 FOUR COPIES)/ <br />Lor/ lI BmcK[�.oF + �L% •� /'`�• <br />1011 ADOR[SS <br />oe <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 COND. UNITS—H.P [A <br />BATHTUB <br />REFRIGERATION UNITS—H.P. FA <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />CAS DRED AC UNITS —TONNAGE FA <br />KITCHEN SINK A DISP. <br />FORCED AIR SY'STI.SIS—B T.U. v I A <br />DISWASHER <br />WALL HEATERS —IT T. U. Al <br />LAUNDRY TRAY <br />UNIT HEATERS—B TU M <br />CLOTHES WASHER <br />EVAPORAIIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE )FOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— CF M <br />VACUUM BREAKERS <br />/ <br />SIOVE <br />ROOF DRAINS —RAINL FADE RS <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERVICE—BAR, ETC) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTALFEE S <br />• <br />na <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FLE <br />RECEIPT NO, <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑m ONO <br />FEES <br />VALUA71ON <br />Err <br />TYPE OF CONST. <br />OCCUPANCY CROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC LOAD <br />PLUMBING <br />.!RE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />YES nNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B C, <br />SEC. T01(a) <br />2. BUILDING PUNS <br />) FIRE HYDRANT <br />TOTAL <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED BN THIS SPACE) THIS 15 YOUR PERMIT <br />5. GRADING/EX(:AVATION A CLEARINGIGRUIIIIING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICAI ION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE 111' <br />9 1 79 <br />