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I <br />APPLICATION FOR <br />CITECONSTRUCTION <br />OF <br />CITYOF <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERiTT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />Ow,�kR // /,' _ . MAILADDRISs / CIR ZIP PITON' . <br />Y n / <br />CLASS OF WORK / `A <br />KNEW ❑ADDITION ❑ALTERATION ❑REPAIR DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OFW05K <br />S AW �/� O <br />DESCRIBE WORK - <br />sy 1 I HERE <br />uoF BY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />AP- <br />Paoros[D uHERE ION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LFCAI DES RIP110N OF PROPIRIYISNON'N BIIOw OR ATTACH HOUR COPIES) <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />LOT _RLOCK—OF 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 ALIT HORIZED AGENT DATE <br />TOR ADoalss I Q ,w i� /7/_. n__.,.il...� /�//04�// <br />iEi NJ �mrxww.CGs.In <br />- — '-- <br />MECHANICAL <br />PLUMBING <br />FEE <br />FEE <br />NO. TYPE OF EQUIPMENT <br />NO. TYPE OF FIXTURE <br />AIR COND UNITS —HP EA <br />51'AIER CLOSET IF OLI ET) <br />REFRIGERATION UNITS —HP EA <br />BATHTUB <br />EA <br />LAVATORY (WASH BASIN) <br />A$ FIRED A C UNITS —TONNAGE FA <br />GAS FIRED <br />SHOWER <br />FORCED AIR SYSTEMS—B 7 U M EA <br />KITCHEN SINK 6 DISP <br />W'AlL Diu 1 U M <br />DISWASHER <br />UNIT HEATERS —BTU M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE N <br />AIR HANDLING UNIT— C F M <br />FLOOR GRAIN <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK IS(RVICE—BAR. F TC 1 <br />i <br />L <br />SUBTOTAL IF <br />SUBTOTAL <br />PERMIT <br />S <br />PEaMIi <br />f <br />FE[ IF <br />f i <br />TOTAL <br />TOTAL FEE <br />StREIT SETBACK REAR <br />YARD SETBACK <br />PLAN CHICK f:L'MIS[B <br />PLAN CHECK FEE <br />SIDE YARD SETBACK <br />i.l RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />F[[ <br />OYES ONO <br />TYPE OF CLOST <br />OCCUPANCY GROUP NO <br />OF DWELLING UNITS <br />BUILDING <br />5 <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BF GROOMS <br />SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />C1YFS LINO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PINAITY <br />SEC ]offal <br />SEC 3 <br />Z BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPIRLY VALIDATED(IN THIS SPACE) THIS 15 YOUR PERMIT <br />5 GRADINGIEXCAVATION6 CLEARINCIGRUBRING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />0 <br />