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UIl Ewfgmn <br />CITY OF <br />APPLICATION FOR <br />.RONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />ITY HALL 2598745 <br />C <br />EVERETT. WA98201 ElCOMBINATION ❑ BUILDING ❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />OW'NLR <br />MAIL AODKISS <br />CII, <br />ZIP <br />PHONE CE —34Z'99207 <br />KI,02L KL.ASMAIJ <br />56.23 120G961:2L1-&Q <br />9cPZD3 <br />355=-1g1z <br />ARCHITECT ORDE SIGN[ R <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />— S^ME— <br />CENTRALCONTRACTOR <br />MAIL ADDRESS <br />Cliv <br />ZIP <br />PHONE LICIASEI <br />— SRM&'- <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE F <br />/A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />7IP <br />PHONE LICENSE F <br />NIA <br />❑NEW y^ L^tADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE D13UILDING RELOCATION <br />VALUATION OF WORK _ _ B D <br />_Z_ T �c]l;-- `OM <br />ITT SCRIBE WORK V• I06� <br />/'G Z51On 12'7' <br />V.. VII <br />PROPOSEDIISE OF BULDING <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 COMPLIEJ 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 />51GNAIURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OT PROPERTY [SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT _aL—FROCK�OF uR G _ E/G' CLra4LY.v <br />To 104/7z7- TyeleBof- Al <br />,� J- ,nE <br />R4F �RDS pfL Tf�E f�l/GYTO2 avf 7efl <br />loll Ail <br />,5;�23 �ock� tcEFe .9vE. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIFT) <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS —HP FA <br />LAVATORY (MASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />CAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK R DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALL HEATERS—B 7 U M <br />LAUNDRY IRM. <br />UNIT HEATERS—B 7 U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— CIM <br />VACUUM BREAKERS <br />STOVE <br />ROCH DRAINS—RAINLEADER5 <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. EIC I <br />SUB TOTAL <br />Sul TOTAL S <br />PERMIT S <br />PERMIT l <br />TOTAL FEE Y <br />TOTAL FEE It <br />41UI YARDS[ T BACK <br />�o F <br />STREET S�TBACK <br />4T2 <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />50.55 <br />PLAN <br />FEI <br />1q. b'a <br />CHECK <br />RECEIFEE <br />T NO <br />USE ZF}T.�NE <br />LOT AREA <br />VACANT SITE <br />OYES LBNO <br />TIES <br />VALUATION <br />FEE <br />IVPLi0! COIN - r <br />tV7� 'V <br />OCCUPANCY GROUP <br />"^ l <br />NO. OF DWELLING UNITS <br />/ <br />BUILDING <br />SIZE Of BLDG <br />NO OF STQRIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONLS <br />BASEMEN <br />III UROOAIS <br />FIRE SP0.1NKlE RS <br />REQUIRED <br />C1YfS NO <br />MECHANICAL <br />— <br />APPROVALS <br />lY <br />On1I <br />BITTER <br />1 ENVIRONMENTAL CHECKLIST <br />PENALTY <br />UBC <br />SIC JB IIa)' <br />2 BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />F FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />/rL C— <br />5 GRADINGIIKCAVATIONACLEARINGIGRUBBING <br />b DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />L HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECCJKED BY <br />V, ` I <br />APPR FOR ISSUANCE BY <br />9.179 <br />