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APPLICATION FOR <br />the <br />°"° CETYOF..ONSTRUCTION <br />CITY OF <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING <br />IN) <br />MAIL <br />CITY <br />PERMIT NO. <br />everett <br />e <br />— SAME— <br />_ <br />GIN[ RAL CONTRAC I OR <br />MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />— SAME - <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />iv/A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONF LICENSEE <br />MIA <br />CLASS Or WORK <br />❑NEW PgADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE El BUILDING RELOCATION <br />VALUATION Of %%ORK <br />IL WORK <br />r ,9i P,01?P.T <br />M <br />PROPOSED USE Of BUILDING <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 />IL NATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE 7o j /�. <br />j�' <br />IEGAI DESCRIPTION Of PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT �BIOCK �.. or dA5'vREG HE/G'ff7r cCQIU,F'N <br />7-22 P�,�7' TifEREof YQCCOfz.OEO IN <br />f 7' E5'4 <br />%ZE�p7RDS Of THE �g//LYT02 �fifi'E <br />�,QU/V/ �• S/U(/%���!�ru / /�' 0�-L✓nii.� <br />J �J.w <br />ION All 1F SS <br />S� 3 EPockF �E� ,4vE. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO, <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLILiI <br />AIR COND UNITS-H P [A <br />BATHIUB <br />REFRIGERATION UNITS -HP [A <br />LAVATORY (WASH BASIN) <br />BOILERS -HP LA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-B T U MIA <br />D15WASHLR <br />WALL HFATERS-BTU M <br />LAUNDRY TRAY <br />UNIT HEAILRS-DTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WAFER HLATtR <br />CLOTHES DRYERS <br />URINAL <br />VE NTILA710N FAN <br />DRINKING, FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F AT <br />VACUUM BRL AKERS <br />SIOST <br />ROOF DKAINS-RAINLEADtRS <br />A1F1AL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR ETC) <br />SUB TOTAL <br />SUB 70TAL f <br />PERMIT S <br />PERMIT f <br />TOTAL FEE B <br />IOTAL FEE S <br />SIO[ YARD S! TBAf I: <br />/„ <br />CV <br />STREET SETBACK <br />, / a / <br />. <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />Q� <br />50.1J5 <br />PLAN <br />F ( �, <br />F 15 <br />CHECK FEE <br />RECEIPT NO. <br />USE 7.}n t <br />(/ .. <br />LOT ARIA <br />VACANT SIj E <br />❑YE$ 910 <br />F[f5 <br />VALUATION <br />FILE <br />IYPEfffl•••1F___�C7OON. _ � r <br />W990 <br />OCCUPANCY GROUP <br />X/ l <br />NO OF DWELLING UNITS <br />BUILDING <br />51ZE%F TIED(:�� <br />7 <br />NO OF STI�RIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />2 <br />1:1APPROVALS <br />BASEMENT <br />1. <br />III DROI).ri <br />___ <br />FIRE SPRINKLERS <br />REQSIREDO <br />MECHANICAL <br />BY <br />DATE <br />OTIIIR <br />T ENVIRONMENTAL CHECK LIST <br />PENALTY <br />L 11 C <br />MC UIII aI <br />2 BUILDING PLANS <br />TOTAL <br />(' <br />`Cr <br />ci <br />1 FIRE HYDRANT <br />R FIRE PROTECTION SYSTEM <br />S GRADINGIEXCAVATIONBCLIARIN(;ICRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />2L'• 11j� yam/ (—� <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />i � .O <br />APPR FOR ISSUANCE RY <br />