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TM EYBEPEPNI APPLICATION FOR <br />CITY OF ZONPE MITTION °B <br />everett <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-9745 <br />EVERETT, WA 98201 DCOMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN10. MAIL ADDRESS CIl1 ZIP PHONE <br />_Tc V­LI A;ts++P 91 rr, S7 Fi�LV_ °rz-2nl <br />AIFCHHECIO D— MAIL ADDRESS <br />Clly ZIP PHONE <br />GENERAL CONTRA)FOR MA11 ADDRESS q1Y ZIP PHONE <br />LICENSE ITart' ��.Lti oe 2 o V_ 0IS-4UI aY�Z, ccd's�sy/7 <br />MECHANICAL CONTRACTOR MAIL ADDRESS ��.. .._ <br />NU'dBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />LICENSE IF <br />❑NEW ❑ADDITION ❑ALTERATION ❑RFPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑CARAIa (1Ruunwr ou n.-..n. <br />DESCRIBE WORK <br />------------ <br />PROPOSED USI 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 />'E 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 />MECHANICAL <br />LEGAL DESCRIPTION Of PROPIRIY(SHOW'N BELOW OR ATTACH FOUR COPIES) <br />LOT?-' BLOCKi OF 17J-I+7- &1/ LEa, .- c L,i " <br />IDB.L1 PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />WATER CLOSE I fIOLICH <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />AIRCOND UNITS -HP LA <br />FEE <br />BATHTUB <br />REFRIGERATION UNITS-H P [A <br />I AVAIORY (WASH BASIN) <br />BOILERS -HP [A <br />SHOW 1 R <br />CAS FIRED A C UNIT S- TONNAGL EA <br />KITCHEN SINK A DISP <br />IORC[D AIR SYSTEMS -BTU M EA <br />DISWAS14IR <br />WALL HEATERS-B T V M <br />IAUNDRY TRAY <br />UNITMUTERS-3TU M <br />CLOT Mf S N'ASI/1 R <br />f VAPORATIVE COOLERS <br />WATER III ATILT <br />CI OT Hfi DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANG[ MOOD <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />DRAINS-RAINL(ADL RS <br />SINK (SE RVICL -BARL IC I <br />McTROOF <br />SUB TOTAL <br />AL { <br />PERMIT { <br />SUBMIT { <br />TOTAL FEE ISTOTAL <br />f[F { <br />SIDE YARDS[ TRACK <br />SiRI IT 51 (BACK <br />REAR YARD SI TRACK <br />PLAN CHICK NUMBER <br />J / 9� / �4 <br />PLAN <br />TEE <br />CHECK FEE <br />RECEIPT NO. <br />U5L ZONE <br />I IOT ARIA <br />VACANT SI7C <br />❑YES DND <br />FEES <br />VALUATION <br />FIE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />I LIEDING <br />I / �.i •'_ <br />O <br />_ <br />S <br />SIZE OF BLOC, <br />NO OF STORIES <br />MAX OCC LOAD <br />ItUMBING <br />FIR[ ZONE <br />BASEMENT <br />III UROOMS <br />FIRE SPRINKIERS <br />REQUIRED <br />❑YFS ❑NO <br />A'ICNANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHICK LIST <br />PENALTY <br />�l-Bc-c3oll.) <br />2 BUILDING PLANS <br />] FIRE HYDRANT <br />WEAL <br />R FIR[ PROTECTION SYSTEM <br />PERMIT VALIDATION <br />W'HLN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />— — <br />5 GRADING4 XCAVAT ION b CI I ARINGICRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />A HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKFD BY <br />APPR <br />IOR ISSUANCE BY <br />