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APeLICATION FORr-7711, <br />CONSTRUCTION e everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 7S9.8745 <br />EVERETT, WA98281 <br />[]COMBINATION �N BUILDING <br />❑MECHANICAL ❑PLUMBING <br />PERMIT NO. <br />OWMR -.) <br />null ADDRESS <br />CJ 21l' <br />PHONE <br />.0 <br />3 - 7S� Y <br />ARCIIITEC <br />OR DESIGNIR <br />MAIL RE51% <br />GINERE/L CONTRACTOR MAIL ADDRESS CITY- LIP PHONE IICEN,tI <br />A... ,, ?�1 4,_,,- ;1// 7l/.I 1,/ 3S37S <br />CONTRACTOR <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIT' PHONE LICENSE, <br />KNEW V^ ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE. ❑SIGN XCARAGE ❑BUILDING RELOCATION <br />V UATION OF WORK CPO <br />' <br />DESCRIBE WORK <br />— . , 1/�.� u Moww/ /l lliGc�QA/ <br />PROPOSED USE OF PUILDIN <br />1 HEREBY CERTIFY THAT 1 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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />7/. CA (] y-_ 't <br />Lot BLOCK Of �' c ur <br />FOR nDORf55 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET QOLIET) <br />AIR COND UNITS-H P. EA <br />BATHTUB <br />REFRIGERATION UNITS -HP IA <br />LAVATORY (WASH BASIN) <br />I <br />))OILERS-H P. EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS- B.T.0 M EA <br />KITCHEN SINK 8 DISP <br />DISWASHER <br />WAIL HEATERS-B. T.0 M <br />LAUNDRY TRAY <br />UNIT HIAIERS-11 T U. M <br />CLOTHES WASI4ER <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 9REAVERS <br />STOVE <br />ROOF DRAINS --RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />SIDE YARD^ SEI BL AK <br />UfLjr--y <br />STREET SETBACK <br />REAR YARD 5E MUCK <br />PLAN CHECK NUMBER <br />PI AN <br />I f l n ,2. 61 <br />CHECK FEE <br />R I�� Q <br />USr ZO t <br />LOT AREA <br />VACANT TF <br />OYES XNO <br />FEES <br />VALUATION <br />Y'AIUATION <br />E <br />FEE <br />TYPE OF CONS'. <br />=_ �J <br />OCCUPANCY CROUP <br />Ad- / <br />NO OF DWELLINC UNNS <br />`_ <br />BUILDING <br />S <br />SIZE OF )LDC, T <br />3o K 3Co <br />NO. OF STORIES <br />1 / <br />MAX. OCC TOAD <br />PLU;.,BING <br />FIRE ZONE <br />BASEMENT <br />HE DROOMI <br />I IRL SPRINKLERS <br />nvrz o <br />"- <br />_ <br />APPROVALS <br />BY <br />DATE <br />OTHI'I <br />1. ENVIRONMENTAL CHECK LIST <br />PlNnl.li <br />Il BC <br />iLC L1llal <br />2 BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT Y'AUDATION <br />WHEN PROPLRLY VALIDATED(IN THIS SPACE) THIS IS YOUR PERMIT <br />'T'} rj�j2T`�' (�s'� �J�• �/ <br />5 GRADING!) XCAVATION A Cl I ARINGICRURBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B H r AL11IDISTRICT <br />