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LM EwrgrPRn APPLICATION FOR <br />CITY OF CONSTRUCTION <br />everett- - PERMIT e <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 <br />❑COMBINATION ❑ BUILDING <br />❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />OWNER <br />MAIL ADDRI SS <br />CIIN <br />ZIP <br />PHONE <br />�IQI(.FP/I�C70A� <br />19/9 Mo0y1<oa[[ <br />EUF_�rf <br />9.C%ta/ <br />.ZS�-DS66 <br />ZRCHITECIOR DISIOM0. <br />MAIL ADDRESS <br />1Y <br />ZIP <br />PHONE <br />444 9R <br />_ <br />GI Nl RAI ONiMCIOR <br />^ MAIL ADDRESS <br />GtY <br />ZIP <br />PHONE LICENSE 0 <br />0 tuuI- R <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />❑TS <br />ZIP <br />PHONE LICENSE 1 <br />PLUMBING CONTRACTOR MAIL ADDRESS LIT, ZIP PHONE LICENSE <br />0(oyeR <br />CLASS Of WORK <br />❑NEW HADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />•) (1 <br />TIES( R191 WORK <br />AA0,, f7,5npvaM q& %,- RAIN ADD A SEal /A/G Roo B1 <br />PROPOSED USI oI BUILDING <br />E A/ a_a <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 NO'. THE GRANTING OF A PERMIT DOES NO'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 />X <br />LIUM 131 SCRIP1104 ofPROP[ 111Y(SHOWN RHOW OR AT TACIT FOUR COPE S) <br />LOT p(-ED BL DCK -'jJOl oP V E ✓ GRT Cr <br />D <br />p <br />I / 117 Mc boq a (� <br />Tux ADDRESS <br />PLUMBING <br />MECHANICAL <br />r1U. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIFTI <br />AIR COND UNITS -HP LA <br />BATHTUB <br />REFRIGERATION UNITS -HP [A <br />LAVATORY IWASH BASIN) <br />Q <br />BOILERS -HP EA <br />I V <br />SHOWER <br />0 <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK 6 DIST' <br />FORCED AIR SYSILMS-B T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />IAUNDRY IRA', <br />UNIT HFATERS-BI U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CIOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNIAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CFM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLI ADFR'S <br />.Mf TAT FIREPLACF 6 CHIMNEY <br />SINK (SERVICE-IIAR. ITC) <br />SUB TOTAL <br />SUB TOTAL B <br />PERMIT <br />E <br />PERMIT R <br />TOTALFEE <br />S <br />TOTAL FEE B <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />(5a//0�';9 <br />PLAN <br />FEE j <br />�� y— <br />CHECK FEE <br />RECEIPT NO. <br />,� .20 <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />GYES CNO <br />FEES <br />VALUATION <br />Fit <br />TYPE OF CONST <br />=-IV <br />OCCUPANCY GROUP <br />ri :: i'•1[ F 2' <br />NO OF DWELLING UNITS <br />I <br />BUDDING <br />((��/Y <br />$"1-cx E-Cit7 <br />4C4 <br />Z: <br />SIZE OF BLDG <br />ArpC J 24o S-F i <br />NO OF STORIES <br />I <br />MAR OCC LOAD <br />— <br />PLUMBING <br />O(, <br />FIRE ZONE <br />BASEMENT <br />— <br />IIIDROO,MS <br />-- <br />FIRE SPRINKLERS <br />REQUIRED <br />F7Yf5 rw6 <br />MICHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U 8C <br />SEC SEEN.)] <br />BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />I FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT <br />S GRADING4RCAN N ION 6 CLMRINGIGRUBRINC <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STA"MENT <br />8 HEALTH DISTRICT <br />_ <br />APPLICATION ACC 8Y <br />PLANS CHECKED BY <br />I!(c)II <br />APPR FOR ISSUANCE BY <br />—1 <br />j <br />