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APPLICATION FOR <br />CITY OOF [APECONSTRUCTIOI. <br />f <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT,WA98201 ❑COMBINATION El BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />CENTRAL CONTRACIOR MAIL ADE`R15S CITY ZIP PHONE LICLNSII <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY LIP PHONE LICENSE <br />1-01 Alums] 11 11 ur 1'Hurv1 1'11 rot <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />f <br />OI SCRIBE WORK <br />PROPOSIO USE OF 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 DC'S 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 />Sic U.RE OF CONTRACTOR OR AUl R17.LD AGENT DALE <br />V L � <br />/R <br />LLCAL DESCRIPTION OF PROPIRTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK _Of <br />FOB ADOPTS$ � <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIET) <br />AIR COND UNITS -HP [A <br />BATHTUB <br />REFRIGERATION UNITS -HP [A <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UNITS-70NNAGE [A <br />KITCHEN SINK M1 DISP <br />FORCID AIR SYSTEMS -Ill T U MIA <br />DISWASHER <br />WALL 111A7ERS-BTU M <br />LAUNDRY TRAY <br />UNIT P STIRS-B 7 U M <br />CLOTHES SMASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VIN11LA710N FAN <br />DRINKING FOUNTAIN <br />RANGE 400D <br />FLOOR DRAIN <br />AIR HANLI ING UNIT- C F AS <br />VACUUM BRI AKERS <br />510V1 <br />ROOF DRAINS-RAINLIADERS <br />MI TA1 :;REPLACE M1 CLIIMNIY <br />SINK FS(RVICI -OAR, ETC) <br />SUB TOTAL <br />SCAR TOTAL f <br />1_ <br />PERMIT <br />s <br />pJ <br />PERMIT f <br />TOTAL FEE <br />f <br />OIL <br />TOTAL FIX f <br />510E 1ARD SETBACK <br />STPEET SETBACK <br />BLAB YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />LET <br />CHECK FEE <br />RICE IPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SIT <br />DYES ❑NO <br />FEES <br />VALUATION <br />FIE <br />TYPE OF CONS? <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />f <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX DICK LOAD <br />PLUMBING <br />.— <br />FIRE ZONE <br />BASEMENT <br />RE GROOMS <br />11R1 SPRINKLERS <br />R(puIRID <br />nYIS ❑NO <br />MEC14ANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 INVIRONMLNTAL CHECK LIST <br />PENALTY <br />TOTAL <br />LI RC <br />SEC 1011A) <br />- <br />O(� <br />2 BUILDING II <br />1 FIR[ HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRADINOI XCM'A7 PON& CL[ ARINGIGRUBRING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />A HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9179 <br />3 <br />I <br />J <br />