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tIN ELOrgrsmon APPLICATION FOR <br />DI" OF ..O N S'f R U CTI O N everctt <br />everett PERMIT e <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259 8745 <br />EVERETT. WA 98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />IWWR MAIL ADDRESS CITY 21P PHONE <br />I�T�RB/ L. ��Nrft Eli A� %aRb1� �c�IL1E �UEl�f 9Ao �a <br />ARLIIICI OR OIS6I IL AURESS CITY ZIP PHONE r <br />wbo j J �DUIE-S /ae—, 7�]Wee ci //l en <br />GINERAL CONTRACTOR <br />MAIL ADDRESS <br />MECHANICAL CONTRACTOR MAIL ADORE S5 CITY LIP PHONE LICENSE / <br />PLUMBRRG CONTRACTOR MAIL AODRISS CITY ZIP PHONE LICENSE <br />CLASS OF <br />❑NEW <br />VA(UA110N OF WORK <br />E 9-7 It— " <br />OLSCRIBI SYORA <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />vxovos_II�1 Run DING <br />J%J <br />_ O �E FA _ " ry o 4 $ 1_ W <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 />,/ <br />LEGAL DESCRIPTION OF PROPERTY(SHOYIN ALLOW OR ATTACH FOUR COPIES) <br />LOT _RLOCK_or _ <br />ION ADDRl55 <br />n/E <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSLT(TOLIEII <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P EA <br />I AVATORY (WASH BASIN) <br />IIOILLRS—H P FA <br />SHOWIR <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS—B.TU M EA <br />DISWASHER <br />WALL HEATERS—B T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS-11 TU M <br />C LOTHIS WASHER <br />EVAPORATIVE COOLERS <br />W'ATIR HEATER <br />CLOTHES DRYERS <br />URINAL <br />71N7ILAIION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I IOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />SACUUM BREAKERS <br />y <br />S7OVE uCF /q CIIZ ..0 hSf& % <br />ROOF DRAINS — RAINLt AD[ RS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR TIC) <br />SUBTOTAL _ <br />SUB TOTAL f <br />PERMIT IF <br />PERMIT f <br />TOTAL FFE f <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD St )BACK <br />PLAN CHICE, NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONCE <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 />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />(lYFS E'!NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U C C. <br />SEC JOJIaI <br />I BUILDING PLANS <br />J FIRE HYDRANT <br />TOTAL <br />R FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPLRLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGILXLA%'ATION S ITT ARINGiGRUHHING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />91 79 <br />