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EM EYBrgroon APPLICATION FOP <br />CITY OF CONSTRUCTION <br />ever. ett PERMIT e <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA 98201 �' <br />❑COMBINATIOW ❑BUILDING MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN[�(' ///��� /' MAII ADDRI SS <br />_ J � C / YN// P� CITY ZIP PHONE <br />ARCNIiICT OR OTSIGN[R !\Y� V it /��( �'� 1 `p. �/ I - / <br />FA.-. , _ MAIL ADDRESS LIT / ZIP Duna. 7 L `j <br />= MAIL Haunt» CITY 21P PHONE <br />LICENSE R <br />ML ', ANICAL CONTRACTOR MAIL ADDRESS <br />_^ OF CIP PHONE <br />LICENSE 1 <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE I <br />Ll A55 OF WORK <br />❑NEW A <br />VALUATION OF WORT <br />f <br />DISCRI/q/j/�WypJq,K <br />/.I/ /INC <br />❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RC1nPAnnu <br />h- = Ea",_P fk,p i <br />PROPOSED USE OF UILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />LEGAL 01 SCRIPTION OF PROM RTYESHOWN BE <br />.AP <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALI <br />IOW OR ATTACH <br />IOUR COPILSI <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />LOT _ BLOCK _of <br />TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />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 />SIGNATLI{lE OF CONTRACTORAUTHORIZED AGENT DATE <br />LOB AODRISS <br />mca <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE <br />FEE <br />NO. <br />WATER'; OSfT I7OLIE TI <br />TYPE OF EQUIPMENT FEE <br />BATHTUB <br />AIR COND UNIT$—H P EA <br />REFRIGERATION UNITS—H P FA <br />U \'ATORY I\YA$H flA51N1 <br />BOILERS— I P EA <br />SHO.VfR <br />GAS FIRED AC UNITS —TONNAGE FA <br />KIICHEN SINK A DISP <br />FORCED AIRDISWSYSTEMS—BTU MCA <br />WALL HEATFRS —B T U M <br />LAUq RY T <br />TRAY <br />UNIT HEATERS T U M <br />CLOTHES <br />CLOTHES WASM[R <br />WATER {;EATER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />AIR HANDLING ON'.T—C.F M <br />ROOF DRAINS —AERS <br />STOVE <br />SINK (SERVICE —BAR. <br />R, ETC <br />ETC I <br />METAL FIREPLACE A CHIMNEY <br />SUBTOTAL <br />iUt TOTAL S <br />PERMIT S <br />PUN [HICK NUMBER TOY <br />PERMIT S <br />TOTAL Fit f <br />SIDE YARDS[ TRACK <br />STREET SETBACK <br />REAR YARD S! TRACK <br />nN CHECK FEE <br />RECEIPT NO. <br />US! ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />Fit <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELL - . UNITS <br />BUILDING <br />y <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRF ZONE <br />BASEMENT <br />ILL GROOMS <br />FIRE SPRINKLERS <br />MECHANICAL <br />REQUIRED <br />nyfS ❑NO <br />APPROVALS <br />BY DATE <br />OTHER <br />—' <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UPC <br />AC 701(AI <br />2 BUILDING PLANS <br />l FIRE HYDRANT <br />TOTAL <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIIXCAVATION 6 CLIARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT SIA7EMEN1 <br />