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APPLICATION FOR <br />CITY <br />ri.everett <br />DOF CONSTRUCTION <br />PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9B201 []COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS CITY ZIP <br />Fik's.r /°�iSrY7c��.n� C 14,✓eci-1 zc.J4 hoc/ccFEL[E2 9AZa/ <br />PHONE <br />2S7. 7/, 9 <br />ARCHITICT OR OLSIGNIR MAIL ADDRESS CITY ZIP <br />Sy cn.Fac S r•v 4s5o<-. moo, scv" 6 Zx-414&-wco /tivsG <br />PHONE <br />775 -793�/ <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP <br />�7 <br />y.EWG Q �O �n/c moo. do < 7SO EVf/1.E/T 7L%0 Oti <br />PHONE LICENSE 1 <br />ZZf �Y <br />2.5y-%/2/ n/r- ✓t-At'-+'.3`/j <br />C LWST <br />MECHANICAL CONTRACTOR MAIL ADDRESS L17Y ZIP <br />PHONE <br />LICENSE 1 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE IF <br />CLASS OF WORRY�--,,(( <br />❑NEW ITf ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN <br />❑GARAGE ❑BUILDING RELOCATION <br />VALIJA71ON OF WORK <br />'s/Z/ <br />A yoo. Do <br />DESCRIBE WORK <br />PROMISED USE Of BUILOINC <br />CI L xcN <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />? _ 1 cE - e <br />X J <br />LEGAL DESCRIPT ION OF PROP(RTY(SHOWN BELOW OR ATTACH FOUR COPIISI <br />LOT _BLOCK -Of <br />JOB ADDRESS <br />2 %.i6 /�orA'EFELLL:C <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND UNITS-H P EA <br />BA)HIUB <br />REFRIGERATION UNITS -HP FA <br />LAVATORY (WASH BASIN) <br />BOILERS-H P EA <br />SHOWER <br />CAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHER <br />WALL HLATERS-BTU M <br />IAUNDRN' IRAY <br />UNIT HEATERS-B T U M <br />CLOTHES WASHEREVAPORATIVE <br />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 />STOLE <br />ROOF DRAINS-RAINU AD[ ITS <br />Mil Al FIRIPLACE A CHIMNEY <br />SINK (SERVICE -BARE TC I <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT <br />f <br />PERMIT f <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />SIDI YARD SIIBACK <br />STITH T SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />iI aI <br />PLAN <br />FEE��3 <br />6 � <br />CHECK FEE <br />RECEIPT n <br />/ <br />USE ZONE <br />LOT AREA <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 />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRREQUIRE <br />❑YES ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />T ENVIRONMENTAL CHECK UST <br />PlNAITY <br />U.BC. <br />SEC SEMI) <br />] BUILDING PLANS <br />Tout <br />2 <br />5 L <br />) FIRE HYDRANT <br />A TIRE PROTECTION SYSTEN <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADING4 XCAV.STIONACLLARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />A HEALTH DISTRICT <br />APPLICATION ACC flY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />