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fM EYBFprBBn <br />APPLICATION FOP <br />GIEYOF <br />ZONSTRUCTION <br />�Y�rcEL <br />everett <br />PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT <br />SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA9R2D1 []COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING <br />PERMIT NO. <br />�-- OWNER <br />MAIL ADDRE SS CI11 ZIP <br />PHONE <br />'ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />NAIL ADDRESS CITY ZIP <br />PHONE <br />LICENS[ 1 <br />MECHANIC7UTONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE R <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE IF <br />CUSS OF WORK,,��Fy <br />❑NEW I9ADDITION <br />❑ALTERATION ❑REPAIR GDEMOLITION ❑FENCE ❑SIGN ❑GARAGE <br />❑BUILDING <br />RELOCATION <br />VALUATION OF DR oe <br />DESCRIBE WORK <br />/ <br />PROPOSED USE OF BUILDING ? <br />/ <br />„ <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 CONSTRUFTION. <br />SIGNATURE OF CONTRACROR OR AUTHORIZED AGENT DATE <br />_ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN RUOW OR ATR COPIES) <br />1� ,,�.. <br />Lodi 7L/ BLOCK �or <br />IOB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE L F FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />W'ATIR CLOSE T (TOLIE7) <br />AIR COND UNITS —II P EA <br />BA1HIUB <br />RE FRIGFRATION UNITS —HP EA <br />LAVATORY (WASH BASIN) <br />ROILIRS—H P EA <br />SHOWER <br />GAS IIRID AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS—B T U M EA <br />DISAVASHER <br />WALL HLATLR5—B T U M <br />LAUNDRYTRAY <br />UNIT HIA7f R5—BTU M <br />CLOTH[5 WASHIR <br />IVAPORATIVF COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION {AN <br />DRINKING, fOUN1AIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLIADIRS <br />MF1A1 FIRfPLACI & CHIMNEY <br />SINK )SERVICE —BAR f TC ) <br />SUB TOTAL <br />SUB TOTAL 5 <br />PERMIT <br />S <br />PERMIT 5 <br />TOTAL FEE <br />B <br />TOTAL FEE B <br />SID[ YARD St TRA0 <br />STRHI Si THM F <br />REAR YARD St TIIAC K <br />PLAN CIE[ K NUMBER <br />Y I, <br />PLAN <br />FIE Sr <br />CHICK FEE <br />RICE IPT NO <br />USE ZONE <br />L07 AREA <br />VACANT Silk <br />OYES DNO <br />FEES <br />VALUATION <br />FEE <br />- <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />DII,Ov {� <br />NO OF UWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG. <br />[)ECK 2_Z9 !;,G <br />NO OF STORIES <br />MAX OCC LOAD <br />NUMBING <br />FIRE ZONE <br />—' <br />BASEMENT <br />IROROOMA <br />I <br />I IRE SPRINKLERS <br />RFQUI RED/' <br />'Yf5 T'NO <br />MICILANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHIR <br />1 ENVIRONMENTAL CHECK LIST <br />PE NAI IY <br />U BC <br />SFC 30Na1 <br />2 BUILDING PLANS <br />TOTAL <br />T I IRA HYDRANT <br />A FIRE PROILCTION SYSTIM <br />5 GRADING(XCAVAT ION&CLI ARING.:CRUBBING <br />PERMIT VALIDA71ON <br />WHEN PROPERLY VALIDATEDIIN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />rkjrn1 <br />APPLE FOR ISSUANCE BY <br />9 1 79 <br />