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the Emproon <br />CITY OF <br />A°PLICATION FOR_ <br />�%.ONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑COMBINATION <br />❑ BUILDING ❑MECHANICAL RPLUMBING PERMIT NO. <br />OWNER MAII ADDRESS r CITY LIY Vim[ <br />WIF }<NFH�• ��►% �OF/I'AL ��'ERE7T %8zo/ z�-��D, <br />ARCHR[[T OR DESICNIR MML ADDRESS CITY [ ZI�A PHONE <br />Rrl <br />ljo <br />GlN}}RM1' .TRACEf OR/� MAIL ADDRESS CITY 21P PHONE IIIIBM• <br />1011 <br />PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />CUSS OF WOR <br />❑NEW &DDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK O� <br />4 l-i Q I <br />DO SCRIBE WORK4% <br />PROPOSED UST Of B nNG� <br />I HEREBY CERTIFY THP.f 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 />X ✓C� / / Z`"-�4L."[_ // _ •L — J l <br />«GAL DESCRIPIF PROPERTY IS H no 'OR Al A aC <br />�J f �, ?— <br />LOT) ^ E� BLOCK �$ OF 7�y j <br />IOB ADDS Cl /�4 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />/ <br />WATIRCLOSEI ITOLI171 <br />-[-'J <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P EA <br />/ <br />LAVATORY (WASH BASIN) <br />/ <br />C'�U <br />BOILERS—H P EA <br />SHOWER <br />CASFIRfOAC UNITS—TONNAGEEA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSIEMS—B T U M EA <br />DISWASHER <br />WALL HEATERS—B T U M <br />LAUNDRY TRAY <br />UNIT IT AT <br />CLOIHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HOMER <br />�( <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 />STOVE <br />ROOT DRAINS—RAINIAADE ITS <br />MITAL FIREPLACE &CHIMNEY <br />SINK ISE RVICI —BAR ETC 1 <br />SUBTOTAL <br />(( <br />(7 <br />SUB TOTAL B <br />Y <br />PERMIT <br />f <br />PERMIT R <br />TOTAL FIT[ <br />S <br />? <br />TOTAL FEE IF <br />Amp <br />ift <br />SIDE YARD 51 TOACK <br />SIRII T SETBACK <br />R[AR YARD SI TRACK <br />PLAN CHICK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />4:5— 2 <br />LOT AREA <br />- <br />VACANT SITE <br />OYES LINO) <br />TIES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />�• 114F, <br />OCCUPANCY GROUP <br />1�L <br />NO OF DWELLING UNITS <br />�� <br />BUILDING <br />S <br />7 3 <br />7 <br />G <br />SIZE OF NLOG <br />NO OF STORIES <br />et, f27✓ <br />Zlm _x'Ijs <br />MAX OCC LOAD <br />•.-- <br />PIUMBING <br />l <br />,e1, <br />l� <br />FIRE ZONE <br />-- <br />BASEMENT BEDROOMS <br />FIRE SPRINKLERS <br />RIQUIREp <br />nvfs W4 <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 [NVIRONMEN7'.L CHICK LIST <br />PENALTY <br />URC <br />SEC TORE) <br />_ <br />2 RUII. DING PLANS <br />TOTAL <br />U 2 <br />UI <br />T FIRE FIYDRAN7 <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN P0.OPE µlY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />5 CRADINCI XCAVAIION R CLLARING:GRUIIING <br />6 DRAINACE <br />7 LNVIRC NMENTAL IMPACT STATEMENT <br />R HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR TOR ISSUANCE IIY <br />91 79 <br />