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everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 25M745 <br />EVERETT,WA98201 ❑COMBINATION ❑BUILDING []MECHANICAL ❑PLUMBING PERMIT NO. <br />CITY ZIP <br />OWNER MAIL AOON[5S / 1 <br />.t,,. - . n_I �._ _ r/ //•/7 �/C /-�nr 4NG fVP Yc%-/ <br />iFP <br />PHONE <br />'LICENSE <br />CITY <br />MAIL ADDRESS <br />/ <br />GENERAL CONIRACTOR <br />S#-X <br />CITY <br />ZIP <br />PHONE <br />110EN5E IFMAII <br />M(CHANICAI CONTRACI rCrOR <br />ADOR[55 <br />,O? c•/-Di-1'-n-R"w-'r-F'1 <br />��� <br />ZIP <br />PHONE <br />LICENSE IF <br />CITY <br />MAR ADDRISS <br />PIUAIBING CONIRACIOR <br />CLASS Of WORK <br />❑NEVV ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE BUILDING RELOCATION <br />VALUATION OF WORK <br />DESCRIBE WORK <br />I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS AP- <br />PROPOSIO USF OF BUILDING <br />{'�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />FECAL DESCPIPTIONCH PROPERTY ISHOSAN RELOW OR ATTACH FOUR COPIES) OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />7 U . '-a e r G %/ OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT �L.LQ-BLOCK OF 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 />TOP ADURl55 <br />X � / <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OFEQUIPMENT <br />FEE <br />NO. TYPE OF FIXTURE <br />FEE <br />AIR CONE) UNITS—H P EA <br />WATER CLOSET (TOLI[TI <br />REFRIGERATION UNITS —HP EA <br />BATHTUB <br />BOILERS —HP EA <br />LAVATORY (WASH BASIN) <br />GAS FIRED AC UNITS —TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS—B T U M EA <br />KITCHEN SINK 8 DISP <br />WALL HEAIERS—B T U M <br />DISW'ASHER <br />UNIT HLATERS—BTU M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER NEATER <br />VENTILATION (AN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />Al HANDLING UNIT— C F M <br />IIOOR DRAIN <br />I STOVE <br />VACUUM BREAKERS <br />METAL (IR[PLACI 8 CHIMNEY <br />ROOf DRAINS —RAINLE ALTERS <br />SINK (SERVICE —BAR LTC) <br />SUBTOTAL <br />S <br />SUB TOTAL <br />PERMIT <br />B <br />PERMIT <br />S <br />TOTAL FEE <br />B <br />TOTAL FT! <br />S <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />SIDE YARD SETBACK 51 REET SETBACK <br />REAR YARD SETBACK <br />FEE <br />RECEIPT NO. <br />USE ZONE LOT AREA <br />VACANT SITE <br />F[!S VALUATION FI <br />OYES []NO <br />__........ry ronuo <br />NO OF DWELLING UNITS <br />OF <br />DRIES <br />1 t71,71 nIS <br />APPROVALS <br />1 INVIRONMENTAL CHECK LIST <br />2 BUILDING PLAITS <br />T FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />S CRAFT%CAVATIONB CLMRINGIGRUBRING <br />INGIF <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />.00uret InN ACC BY PLANS CHECKED BY <br />91 79 <br />BY I DATE <br />APPR FOR ISSUANCE BY <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />UBC <br />PENALTY SEC TOXa) <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />r4Y / <br />