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APPLICATION FOR Ze,e„ <br />CCAS TRUCTION e <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 -1 <br />EVERETT, WA98201 COMBINATION ❑ BUILDING JMECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER <br />R� MI" ADDRISS CITY ZIP PHONE <br />z3gy,ew/ 0,14 J//Gus 06O/ TT 9i201 XS—dr —/6/2 <br />ARCHITECT RDESIGNER MAIL ADDRESS CITY ZIP THOM <br />SELF <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHON1 LICENSEE <br />MAIL ADDRESS CITY ZIP PHONE LICENSE;# <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY TIP PHONE LICENSE E <br />CLASS OF WORK IIC-DII <br />❑NEW IRADDITION ❑ALTERATION ❑REPAIR ❑❑LN <br />DEMOLITION ❑FENCE SIGN CARAGE ❑BUILDING RELOCATION <br />VAI UATIOpN�Of WORK <br />S ! BQ <br />DESCRIBE WOR, % k 17 S K 2 0 <br />moo/7-i0 �✓ TO f/?�° r/v �F- �R RAG E <br />PROPDSFD LIST OF BUBUING <br />4?CS/ G awyl e der <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 OI: 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 />SIGNATUR F CONTRACTOR OR AUTHORIZED AGENT DATE <br />//// <br />X Y <br />ITEM DESCRIPTION OF PIT _)PI REY (SHOWN III IOW OR ATTACH FOUR COPIES) <br />LOT +/ 'PPZK �,- ��� �) �� <br />J—�oF <br />JOB ADDRESS <br />PLUMBING <br />MECHANICA <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIET) <br />AIR COND. UNITS-11 P CA <br />BATHTUB <br />RCFRIG'RATION UNITS-H P CA <br />LAVATORY (WASH BASIN) <br />IIOILERS-H P. 1'A <br />SHOWER <br />CAS FIRED A C. UNITS -TONNAGE EA <br />KITCHEN SINK L DISP <br />IORCFD AIR SYSTEMS-B T L AI I:A <br />DISWASHER <br />U'AL1. HEATERS-B I M <br />LAUNDRY TRAY <br />UNIT HEATI RS-BTU M <br />CLOTHES WASHER <br />j EVAPORATIVE COOLERS <br />WATER HEATER <br />CIOTHFS DRY'FRS <br />URINAL <br />VI NIILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C I M <br />VACUUM BREAKERS <br />STOVI <br />ROOF DRAINS -RAINLFADERS <br />All TAI FRIPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC I <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />Y E <br />STREET SETBACK <br />REAR YARD SL IBACK <br />PLAN CHECK NUMBER <br />^ <br />F� J <br />PLAN <br />FE�y�, <br />Z�G'` <br />CHICK FIE <br />RECEIPT NO <br />U5E ZONE <br />_ <br />LOT AREA <br />VACANT SIZE <br />❑ CA XNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST�. I <br />t� N <br />OCCUPANCY GR _ 7 <br />NZL 7 <br />NO OF DIVE LUNG UNITS <br />IT <br />BUILDING <br />S <br />�`/ 7 <br />�O <br />SIZE OF BL DG 8><Zo <br />7 X I O <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />y <br />FIRE ZONE <br />BASCMFNNT <br />IIIOROOMS <br />�- <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES ONO <br />Nil CHANICAI. <br />APPROVALS <br />BY <br />DATE <br />OTHI R <br />1. ENVIRONMENTAL CIIICK LIST <br />PFNAI IY <br />11 TIC <br />SIC 3071a) <br />2 BUILDING PLANS <br />TOTAL <br />L/ <br />O o <br />1 FIRE HYDRANT <br />I FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />Will N PROPI RIV VALIDATED (YIN� THIS SPACE) THIS IS YOUR PERMIT <br />Z <br />r`N/ <br />5 GRADINGILXGVA710NA CLFARINGIGRUIIBING <br />fi DRAINAGE <br />7 LNVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. FLY PLANS CHECKED BY <br />APPR. IOR ISSUANCE ITS <br />