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the EnrpniRrF <br />CITY OF <br />APrICATION FOR <br />CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-6745 <br />EVERITT. WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS CITY ZIP C/y/� p PHONE 17i l9✓r 'rfifil4f� rJ <br />ARCIAHICI OR DISICNIR MAIL ADDRI SS CITY ZIP PHONE <br />6f NfR CONOIAC'TORMAIL ADqDRE SS CITY ZIP PHONE LICENSEE <br />i/cc S. /�(D cW.9� /�V Z�?r�liw• F/J/7dyo1. `1��2o fY�ii1D zol�3 <br />MICHANIC At CONTRACTOn MAIL AOORISS CITY ZIP PIIONE LICENSE P <br />PI1'AIRISY CONTRACTOR MAIL ADORI SS CITY ZIP PHONE LICENSE AT <br />CI AYALII WORK <br />❑NEW ❑ADDITION ❑ALTERATION XEPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />\ Ali 'AllOy01 WORK <br />00D.0� <br />Illn1( WITH WORK �-� OAS I�• fy�Ur/.✓J� yjUUJ C O <br />f• -if v'/l�L ��.4i� r i 5 AY.� e S 2/ / /LT1 }I tf /,', �Y✓,(/AJ N,/W r <br />rknrDMDL'sT 0r Rwunvc / <br />Uvy�e-� / Jcvf;P G <br />h✓°P /eooc- <br />6/rs <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 OR AUTHORIZED AGENT DATE <br />TIC I OISCRIPTIOR OF PROPIRTI (SHOWN 11110W OR ATTACH FOUR COPIIH <br />uvRlocK oT ' f "� '� <br />H)x ADDRI SA <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE Of FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIETI <br />AIR COND UNITS-H P LA <br />BATHTUB <br />RIf RIGIRATION UNIIS—HP EA <br />LAVATORY (WASH BASIN) <br />BOILIRS—H P EA <br />SHOWER <br />GAS FIRED AC UNITS—IONNAGE EA <br />KITCHEN SINK A DISP <br />FORCE D AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALI HAATERS—BTU M <br />LAUNDRY TRAY <br />UNIT HEATt RS—BTU M <br />CLOTHIS WASHER <br />IVAPORATD" COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />V[NIILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLE ADt RS <br />MITAt FIREPLACE AS CHIMNEY <br />SINK (SERVICE —BAR. I TC 1 <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FFE <br />S1 <br />TOTAL FEE S <br />SIDE YARD SE AB SCK <br />STIFF ET SETBACK <br />REAR YARD SE ABACK <br />PLAN CHI. CK NUMBER <br />PLAN <br />HI <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT ARE A <br />VACANT Silt <br />ONES CNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWI FLING UNITS <br />BUILDING <br />5 F <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />HIDkOOMS <br />AIR[ SPRINKLERS <br />RFQUIRID <br />FISTS [INO <br />MECHANICAL <br />APPROVALS <br />RY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHICK LIST <br />ptNAl7V <br />IF RC <br />SEC 30l(q <br />Z BUILDING PLANS <br />TOTAL <br />^^ <br />1 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />S GRAOINGII X( AVATION A CIA ARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPt RLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />E Hf Al TH DISTRICT <br />'R 109 ISSUANLL BY <br />