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theEYBryAP1°LICATION FOUR <br />rw - .,~� r. - <br />CITY OF _ NSTRUCTIOI. <br />everett PERMIT Ll <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.0745 <br />EVERETT. WA98201 ❑COMBINATION �rBUYLDING ❑MECHANICAL OPLUMBING PERMIT NO. <br />OWNER MAII AOORI SS CITY ZIP PHONE <br />CAR ! 1 �a2,e-c�.. .� P� fl Y E (/G` K-!1f` 2,S' •�'. �� � / <br />ARCHITECT OR DESIGNER O MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP E PHONE LICENSE F <br />n E- J4 i�'is,1 � 5o _f/ rTi/ry r s-Ilt./L/�,_ /J.7... ///.iToA, Z21,2Tr <br />MECHANICAL CONTRACTOR MAIL .ADDRESS A/ CITY ZIP PHONELICENSE F <br />0S- ,-I C- v H r{r� d eA c ell <br />PLUMPING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WOP���� OO <br />S <br />DESCRIBE WORA IF <br />%Dili) %% /,, / G wZi�V.r/A •��A ,ems <br />PROPOSED USE Of BUILDING <br />LEGAL DISCRIPTION OI PROP'RIYLSHOWN BELOW OR ATTACH FOUR COPIL51 <br />�v ? el <br />LOT BLOCK <br />p /�/ <br />.G, ,r /j'k rt�.! ,// // <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 REGULATINr CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SISIGNATURE OF ONTRACTOR OR AUTHORIZED AGENT DATE <br />A /// ��/-L <br />IOBVV`I / /4 gJ/'- <br />,L <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIETI <br />AIR COND UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS —HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS-B.T U. M EA <br />OISWASHLR <br />WALL HEATERS-87 L; M <br />LAUNDRY TRAY <br />UNIT HEATERS-0 T U. AS <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-RAINLIADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK ISERVICE-BAR. ETC ) <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PLRMIT F <br />TOTAL FEE <br />II <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />fit <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 />SIZE OF BLDG <br />NO OF STORIES <br />&LAX. OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BI DROOMS <br />TIRE SPRINKLERSREQUIRED <br />❑YES ONO <br />MECHANICAL <br />A►PROVAL$ <br />BT <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LI5T <br />PENALTY <br />VBC <br />SIC J0J(a) <br />2 BUILDING PLANS <br />TOTAL <br />J FIR[ HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 CRADINGEf XCAVATION&CLIARINGIGRUBBING <br />& DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />