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APPLICATION FOP <br />CITEntgr"n cm of CONSTRUCTION <br />everett PERMIT <br />GEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WAA/9�/81201 []COMBINATION ❑ Y�ILDIING MIEE'/C'H�ANNICAL ❑PLLPUMBING <br />OWNEP�"/".' 1 CG �J•"� MAII�'�i55 `Vv,...�1— �O P <br />&ormi Fft OR ORICNIR MAIL ADDRESS CITY ZIP <br />PERMIT NO. <br />s <br />w <br />GENERAL CON R CTOF`— <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE 1 <br />MECHANICAL CONTRACTOR <br />'t. <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE 1 <br />PLUMBING CONTR� <br />MAIL ADDRE SS CITY <br />ZIP <br />PHONE LICENSE IF <br />CLASS JRK <br />El NIL 0- ADDITION <br />DALTERATICIN ❑REPAIR ❑DEMOLITION ❑FENCE <br />❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />VAIUMION Of WORK U� <br />S <br />DESCRIBjjIIW RK <br />I <br />1 <br />I I", p FLIP A Y1. n.v <br />AJ/ FLY\ Ih -'-G• •� <br />PROPOSLD USE u1LDING <br />LEGAL DI SCRIPTION OFPROPERTY ISHOWN BELOW OR ATTACH TOUR COME 51 <br />LOT _BLOCK —OF <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 />SIGNA7E OF CONIRAACCTOR AUTHORIZED AGENT DATE <br />✓ l—J'4 <br />x <br />'7 <br />TDB AUDRL52IL M�'/�`Y Sl <br />PLUMBING u <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-H P EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE F,l <br />KIICHIN SINK S DISP <br />FORCED AIR SYSTLM5—B T U M EA <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS —BTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <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 />SIOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE IL CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />5 <br />PERMIT B <br />i <br />TOTAL FEE <br />$1 <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />'TREET SETBACK <br />RLAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />fit <br />CHECK FEE <br />RICE IPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ❑NO <br />IFFS <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCLPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF HLOG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />E <br />FIRE ZONE <br />BASE.ME NJ <br />11l UNOUMS <br />FIRE SPRINKLERS <br />EINKLERSREQUIR <br />C)VF5 ❑NO <br />MECHANICAL <br />— <br />APPROVALS <br />BT <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UPC <br />SfC 70)la) <br />2 BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />A FIRE PROJECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED(IN THIS SPACE)THIS IS YOUR PERMIT <br />S GRADINGIIXCAVATION& CLEARING!GRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE By <br />9.179 <br />