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APPJ� CATION FOR <br />everett <br />CC�VSTRUCTION DEPT. OF COMMUNITY DEVELOPMENT SERVICES PERMIT <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION ® BUILDING ❑MECHANICAL ❑PLUMBING <br />933— <br />AKIn <br />I IT) <br />CITY <br />PERMIT NO. <br />PHONE <br />SZ—yYG <br />GENERAL CONTRACTOR Wit ADDRESS CITY ZIP PHONE LICENSE X <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />IF <br />PLUMBING CONTRACTOR MAIL ADDRESS (10 ZIP PHONE LICENSE X <br />CLASS OF WORK <br />❑NEW ADDITION AALTERATION OREPAIR ❑DEMOLITION ❑FENCE ❑SIGN LJGARAGE ❑BUILDING RELOCATION <br />VALUATION OF PORK <br />' Z U00 no <br />Dl ugml rnRc <br />d C-k6tt7- &,TAC Clranl — 6Ass: FJec7-,Z;C4,( Sees,•c,,s <br />r%orosrD ua of nun mNr. <br />s Ak ,q",.,L G`I <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 />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 CONTRACTO UTHORIZED AGENT DATE Zp/26/6 <br />It CAI 1)LSCRIP71ON of PROM REY(SHOWN Buow OR AT TACIT IOTA) c/orn Sl <br />l LOT i o � mockj or 7.e,w G, sTQLOF <br />_Ac r* y 35'0 - 6SS -oo 7- oTao I <br />100 ADDRf SS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTUPE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />I\'ATI R CLOSI I ITCH IT1) <br />AIR COND. UNITS—H. P. EA <br />TIATI17UII <br />REFRIGERATION UNITS-11 P, EA <br />I AVATORY (WASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS--B.T.U. M EA <br />DISIWASHER <br />WALL HEATERS—B.T.U. At <br />LAUNDRY TRAY <br />UNIT HEATERS—R.T.U. AI <br />CLOTHES WASHER <br />I VAPORATIVE 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 />STOVE <br />ROOF DRAINS —RAINLEADE RS <br />METAL FIREPLACE B CHIMNEY <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT <br />S <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />I'I AN CHECK NUMBER <br />/ f• <br />s7F 2 <br />PLAN CHECK FEE <br />FEE /O r RECEIPT NO. <br />USE ZONE <br />EOT ARE!. <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />S p p00 �� <br />Fd <br />SIZE OF BIDG. <br />NO OF STORIES <br />MAR. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />OI OROOA15 <br />FIRE SPRINKLERS <br />REQUIRED <br />L1YE5 ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHICK LIST <br />PENALTY <br />Li El C <br />SIC 303(a) <br />2. BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SI'Al'II THIS IS YnLIR PERMIT <br />5 GRADINGIE XCAVATION A CLEARINGIORUCHUNG <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR HOLE ISSUANCE [IV <br />9.1.79 <br />