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D <br />the EmrgwO APPLICATION FOR <br />CITY OF CONSTRUCTION <br />everett PERMIT e <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9R201 EICOMBINATION 1� BUILDING ❑MECHANICAL UPLUMBING PERMIT NO. <br />OWNER �,� NEAR ADDRESS �� /fir , / CITY ' ,ZIpM G (/ PHONE /��' 2G <br />' ARCHITECT t-vtr N�PEEV'l Wll 3t4 IR MAIL ORA'1S "oI he ll_V 6V� cCD l 1 0201 CITY IF 291 /T 27 <br />GENERAL CONT wIT NiAll ADDRESS CITY LIP PHONE LICENSE E <br />"I�IU�N�CTOR MAIL ADDRESS CITY LIP PHONE UC•.NSEF <br />PLUMBING CONTRACTOR MAIL ADDRESS COY TIP PHONE LICENSEE <br />❑NEW ❑ADDITION IRALTERATION mREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUNIION OF WORK <br />�o Oy <br />DESCRIBE 1YUR1. L� I 1 <br />IJE3n> TIJYACIC04 VUOF. k-dt)'FI*Tw,& Ln 'BWt' )'"&Gu (An .< II E Ia Y_ <br />PROP.)SIOLSE PI TU9HHNC <br />_�-C SLck_� <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 GE.", 1; Y�'1 <br />X <br />LEGNE DESCRIPTION Of PROPERTY ISH�M%N SHOW OR ATTACH FOUR COPRSI <br />�I,12 BI O.R S?I of rr <br />L°' V'LA.t- E <br />3 L( Z 4 (ZV �AQ 16___�_� <br />IUN nI)0R155 <br />PLUMBING <br />MECHANI <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE EQUIPMENT <br />i FEE <br />WATER CLOSET (TOLIET) <br />co <br />AIR. COND UNITS -HP LA <br />BATHTUB <br />00 <br />REFRIGERATION UNITS-1, P EA <br />LAVATORY (WASH BASIN) <br />7C90 <br />I <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE [A <br />KITCHEN SINK A DISP <br />TOP-ED AIR SYSTEMS-B T U MIA <br />DISWASHIR <br />W',Ll HEATERS-B T.0 M <br />LALNDRY TRAY <br />UNIT HEATERS -BTU M <br />CLOTHES W'ASHLR <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I; OOR DRAIN <br />AIR HANDLING UNIT- CFM. <br />VACUUM BREAKERS <br />S10VE <br />ROOF DRAINS-RAINLEADLRS <br />W TAIL EBIEPLACE A CHIMNEY' <br />SINK (SERVICE -BAR. ETC) <br />SUBTOTAL <br />Cal <br />orl <br />SUB TOTAL IF <br />PERMIT <br />3 <br />PERMIT 3 <br />TOTAL FEE <br />3 <br />TOTAL FEE 3 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />Fit <br />- <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />If <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />l!� <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES FIND <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />_ <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />LEBEC <br />SEC SEC JOpa) <br />7 BUILDING PLANS <br />J FIRE HYDPANT <br />TOTAL <br />COL <br />5Z/ <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />W HLN PROPERLY VALIDATED DN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADIN(;J XCAVATION A CUARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HFAI FEE DISTRICT <br />APPLICATION ACC. BY <br />L. %/ <br />"LANS CHECKED BY <br />APPR [OR ISSUANCE BY <br />:_- . C_ . <br />I <br />I <br />i <br />9-1-79 <br />