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r <br />APPLICATION FOR <br />The tITYOFro"`'' LON5TRUCTION w <br />m P <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES 331/ 5v6 3 <br />CITY HALL 259-E745 <br />T EVERETT, WA9e201 COMBINATION El BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. !'✓ <br />OWNER NAIL ADUBT11 ^ (Ill JII` PIIDv'1 <br />V "I <br />ARCHITICTO'g'�CSICItRR <br />rd� <br />LLII/ MAIL AIIDRISS <br />gIlV U'L� 'T. �. <br />�- CITY <br />-,xJ� -.3S <br />ZU' <br />�Iu <br />PHONE <br />��'U)1 <br />zI <br />CENTRAL CONTRACTOR <br />k9AIL ADDRESS <br />CITY <br />LEIS <br />PII,N [L <br />a <br />l T 1 1 <br />l <br />A,^/�� Q/��1�15/f�� <br />MECHANICAL CONTRACTOR <br />ANTI ADDRESS <br />CITY <br />LIP <br />PHONE <br />LICENSE• <br />PLDMXINC CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIT' <br />PHONE <br />LICENSEE <br />L <br />L <br />❑NEW V^ DDITIO ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />SALVATION OI NVRK <br />'� OC o Z) <br />DESCRIBE WORK <br />PROPOSED USE DI BUILDING <br />I (y j'�( QJ Lq"1� 7✓` r S <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICAT ION 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 AUTHORITNTO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONS T CTION. <br />SICNATU F CONTRACTOR UTHORI D AGENT DATE <br />/l 7 <br />LEGAI Of3 RIPTION Of FROM FLY ISHOSAN DOZY OR ATuu11OURCOP'IS1 <br />t zl� fZ /3 <br />LOT _BLOCK FAA of _ <br />�T <br />/ I U } K T , <br />d/ <br />IOB ADDN RI <br />3c1� Io�.kct fir. <br />PLUMBING <br />MECHANICAL I <br />NO. <br />TYPE OF FIXTURE <br />Fit <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />SS'AIlR C1t1S! 1 0OLll II <br />AIR COND UNITS —HP !A <br />BATHIUB <br />REFRIGERATION UNITS-11 P EA <br />LAVAIONI nSANH BASIN) <br />BOILIRS-HP EA <br />SHOW I R <br />CAS I IRI D A C UNITS- TONNAGE EA <br />SITCHI N SINK A ONE' <br />H1R(11) AIR SNSTEMS—B T U MIA <br />DISWASHIR <br />SSMI HIATIRS-BTU AT <br />IAUNDRI IRA) <br />CFII HEATERS -BTU AS <br />CLOUH S SS ASHI R <br />I SAPORATIVI COOLERS <br />WATER III AI (R <br />(IOTHI S DRYERS <br />URINAL <br />SI N I II ATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I LOOR DRAIN <br />AIR HANDLING UNIT- C 1 M <br />VACUUM BREAKERS <br />STOSI <br />ROOT DRAINS-RAINI I ADI RS <br />SHEAF I INI PLAQ A CHIMNI Y <br />SI%K INIRSHI-BAN III I <br />I <br />u rL,'7 <br />SUE TOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FIE S <br />SIDI YARDSTTSICK <br />5 F'T <br />STREET SETBACK <br />20P <br />HE AS YARD SF113ACK <br />'zo - <br />PI AN T I KES NL%,HIR <br />0W /m /Q <br />`/ <br />PIAN <br />Ill <br />CHECK IIF <br />Rf CLIP�1y NO <br />USE ZONE <br />PL/_ <br />LOT AREA <br />4Svo47 <br />VAUNT SDI <br />LJYES L�fQ <br />IFIS <br />VALUATION <br />F[[ <br />TYPE OI'1F (ONSI <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ IZEG�' <br />y�� <br />9 Z <br />SIZE OFBLDG <br />AVE),4 13(o j , � <br />NO OF STORIES <br />I <br />MAR OCC LOAD <br />PLUMBING <br />(1- <br />FIRE ZONE <br />_ <br />BASEMENT <br />^ <br />IIIDROOMS <br />-- <br />FIRE SPRINKLLRS <br />REQUIRED <br />FISTS REQUIRE <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTIIIR <br />1 ENVIRONMENTAL CHECK LIST <br />1'lNAI IN. <br />OTC <br />Sit LOW <br />lz-�a <br />7 BUILDING PLANS <br />TOTAL <br />['X <br />l A <br />T FIRE HYDRANT <br />FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGII XCAVA T IONA CL 1ARINGIGRUHHI NI, <br />B DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />E HEALTH DISTRICT <br />APPLICATION ACC BY <br />E <br />PLANS CHECKED BY <br />>1u;r1) <br />APPLE FOR ISSUANCE BY <br />C r C . <br />9179 <br />9 <br />J <br />