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APrICATION FOR RYRn„ <br />G"OF CONSTRUCTION <br />everett PERMIT <br />DEPT OF':OMMUNITY DEVELOPMENT SERVICES <br />CITY HALK 259-6745 <br />EVERETT. 1VA 98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNIR MAIL ADDRISS Clh IIP p PHOW <br />.�,,A� b FvLz�Pllc G 7a,Z 2,z6,l -(16. <br />ARCHITECT v <br />ZIP PHONE <br />GI NIRAL COWRAITOR <br />ct,'n<c S. <br />MAII AOpXl55 <br />CITY ZIP <br />PROM <br />LICENSE a <br />occ�Ci9� <br />%S�V <br />2��r��icy <br />�/7dvoJ i�U�a <br />fYC1f( <br />AR [HANILSI CONI0.ACI0R <br />MAIL ACTOR[$$ <br />CITY ZIP <br />PHONE <br />IF oIJ? <br />LICENSE a <br />PD•NRINC CONTRACTOR MAIL NUCLEI SS CITY ZIP PHONE LICENSE IT <br />CI UY OF 1SORK <br />❑NEW ❑ADDITION ❑ALTERATION PAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />Y AL V AI IO' VOI "ORK <br />S gt)a,00 <br />11111 RIRI N(1RK _ <br />fCP� /✓� ,-i- Gc r!l/✓�'c e .iPcii/%t'G �J�., r J ��5 iS /,'�'o✓I�% n 1 i�i u �.ca.,. ��.��,� ,.�,1,/Ir�t.oc e <br />PROPOSIO INC 01 RWIDINC. <br />.o�l�'Lex 'tA�/PC. <br />a o,G <br />(� AP*V GcIs <br />. - - 11 1 1 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 />Ok 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 />SICNA7URL Of CONTRACTOR OR AUTHORIZED AGENT DATE <br />S/SS/O U <br />x <br />UGM OI SCRIPTION OF PRON RTY ISHOWN RUOW OR AT NCH FOUR COPH SI <br />RIocKofIj <br />111N A110.I <br />[a�� .s� <br />PLUMBING <br />MECHANICAL C <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />W'ATIR CLOSE I 1701.I17) <br />AIR COND UNITS —HP EA <br />BATHTUB <br />RFFRIGERAIION UNITS—IIP [A <br />I AVATORY (WASH BASIN) <br />BOILf RS—H P [A <br />SHOWTR <br />GAS FIRED AC UNITS —TONNAGE FA <br />XI7CHIN SINK B DISP <br />IORC1D AIR SYSTEMS—B T U M [A <br />DISWASHFR <br />WALL HEAIERS—BTU M <br />LAUNDRY TRAY <br />UNIT 14EATERS--01 U M <br />CLOTHS WASHER <br />1VAPORATIVF COOLERS <br />WATER HEATER <br />CIOTHE S DRYF ITS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />Sim[ <br />ROOF DRAINS—RAINU AD[ ITS <br />All TAI fIREPLACF IS CHIMNEY <br />SINK (SERVICE —BAR. EEC) <br />SUB TOTAL <br />SUN TOLRL S <br />PERMIT <br />L <br />PERAEIi B <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD 51 TBACK <br />PLAN CHICK NUMBER <br />PLAN CHECK FEE <br />SEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YFS CNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONS[ <br />OCCUPANCY CROUP <br />NO OF DWELLING UNITS <br />9UII DING <br />5 <br />T <br />SIZE Of FILDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASF MF NT <br />BI DROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />RYES RNO <br />MECHANICAL <br />APPROVALS <br />/Y <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SIC 7UXa) <br />7 BUILDING PLANS <br />1 FIRE HYDRANT <br />TOTAL <br />Ck <br />A FIRL PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROP! RLY VALIDATED (IN THIS SPACF) THIS IS YOUR PERMIT <br />S CRADINC11 KLAVATION A OF <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT 57ATEMENT <br />R HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APP/R/ FOR IISSSUANC BY <br />91.79 <br />