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TAB EwrprPBD <br />CITY OF <br />APPLICATION FOR <br />CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINA'.ION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />C 111 ZIP PHONE <br />OWNIR MAIL ADD RRS _ n <br />ZIP <br />eve7eD <br />e <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK ❑NEW ❑AA��ADDITION ❑ALTERATION [n REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE OBUILDING RELOCATION <br />VALUATION OF WORK <br />Y <br />DLSCRIBT WORK <br />USE OF <br />LEGAL DESCRIPIION Of PROPERTY (SHOW, <br />LOT i } �' BLOCK,JlPE� L OF �L <br />7 <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 TH15 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 />x Ur 4rr��uy: 5^--) 4 <br />-37:2 �2 Lr 7, I <br />( , <br />MECHANICAL <br />PLUMBING <br />NO. F EQUIPMENT <br />FEE <br />NO. TYPE OF FIXTURE FEE <br />AIR CONEHP EA <br />WATER CLOSET (TOII[71 <br />REFRIGERITS—HP EA <br />BAIHTUB <br />BOILERS <br />LAVATORY (WASH BASIN) <br />GAS FIREITS—TONNAGE EA <br />M <br />SHOWER <br />IORCFD S—B T U AS EAS\'ALL <br />KITCHEN SINK 6 DISP <br />HITU MDISWASHERUNIT <br />— <br />HE F U AS <br />�- <br />LAUNDRVTRAY <br />EVAPORATIVE COOLERS <br />CLOIIILS N'ASHfR <br />CLOTHES DRYERS <br />W'AIIR HEATER <br />_ <br />\'F NTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— C FM <br />IIGOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />MLTAE FIRFPUCE b CHIMNEY <br />ROOTDRAINS—RAINLEADERS <br />SINK (SERVICE —BAR. ETC) <br />SUB TOTAL S <br />SUB TOTAL <br />PERMIT S <br />PERMIT f <br />S <br />f <br />TOTAL F[E <br />TOTAL FIE <br />STREET SETBACK NI nN YARD 51 i11ATK <br />PUN CHECK NUMBER PLAN CHECK FEE <br />SIDE YARD SETBACK <br />FEE RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DYES ONO <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />A <br />��� <br />'�� <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOM $ <br />FIRE SPRINKLERSRFQ <br />MECHANICAL <br />FTYFS ❑NO <br />APPROVALS <br />IV <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />pf NAL1Y <br />UBC. <br />EC lORa) <br />Z BUILDING PLANS <br />TOTAL <br />T 7 <br />1 FIRE 14YDRANT <br />R FIRE PROTECTION SYSTEM <br />PERMIT TI ON <br />WHEN PRROPERLOPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGIEXCAVATION b CLI ARINGICRUBBING <br />h DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />E HEALTH DISTRICT <br />APPLICATION ACC By <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9.1-79 <br />