Laserfiche WebLink
1' <br />d <br />TBB EYRrgmn <br />CITY OF <br />APPLICATION FOR <br />everett CONPERM TTIOh <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />ONNIR MAIL ADOR[SS CITS 21P PHONE <br />/G/7 lie %)e.-, c� �i,v Z- Fv� r c 7-1ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />w <br />CENEKAL CONTRACTOR MAIL ADDRESS CITY M PW,' t LICENSE R <br />2 3 i 35-3 - "-' <br />MECHANICAL CONTRACTOR MAIL ADDRESS CIT1 ZIP C/ PHONE UCEN5IR <br />1_?_?-0/-0/-tA-k'a-4-J r1/)c <br />PLUMBING CONTRACTOR MAIL ADDRESS (ITY ZIP PHONE LICENSE B <br />CLASS Of WORK <br />❑DEALOLITION ❑FENCE ❑SIGN ❑GARAGE [—]BUILDING RELOCATION <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VAWAIION OF WORK <br />SCRIBE WORK <br />PROPOSED USE 01 BUILDING <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 OORR AUTHORIZED AGENT DATE <br />I <br />LEGAL DESCRIPTION OF PROPERTY ISHON'N BELOW OR ATTACH FOUR COPIES) <br />✓ %� <br />LOT 9- /C BLOCK ;e r C- ? 4 Or <br />JOB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (101,1111 <br />AIR COND UNITS—H P EA <br />BATHTUB <br />REFRIGERATION UNI7S—HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP [A <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSIIMS—B 7 U M EA <br />DISN'ASHfR <br />WALL HILATERS—BTU M <br />LAUNDRY 7RAY <br />UNIT HLA7LRS-11 U M <br />CLOTHES WASHER <br />IVAPORATIVI COOLERS <br />WATER HEATER <br />CLOTHES DRY[ITS <br />URINAL <br />V9 NTILA1 ION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I LOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACL UM BREAKERS <br />STOVE <br />ROOT DRAINS—RAINLEADIRS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC I <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />B <br />PERMIT B <br />TOTAL FEE <br />S <br />TOTAL FEE B <br />SIDE YARD SETBACK <br />STRIIT SETBACK <br />REAR YARD SETBACK <br />PLAN CHICK NUMBER <br />PLAN <br />It[ <br />CHECK Ft <br />RECEIPT NO <br />USE ZONE <br />l07 AREA <br />VACANT SITE <br />OYES ONO <br />Ills <br />VALUATION <br />fit <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 />FIR[ ZONE <br />BASEMENT <br />JET DRO(LV6 <br />FIRE SPRINKLERS <br />REQUIRED <br />FIVES("NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PINALTY <br />L IIC <br />TOXB) <br />SIC <br />— <br />2 BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />R FiRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />of/ <br />{/�C i7i r/A%�// /P' `t �//X' ✓ �3Z J <br />/CCC ��' / <br />5 GRADINGIIXCAVATIONBCLEARINGIGRUBBING <br />6 DRAINAGE <br />_ <br />7 ENVIRONMENTAL IMPACTSTATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />