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APPLICATION FOR <br />CITEOF .1JN CITY OF <br />.STRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITYDEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 []COMBINATION El BUILDING ❑MECHANICAL ©PIUMBING PERMIT N <br />ORW+LR MAIL ADDRESS CITY ZIP PHON[ <br />n n _ n n 41._.-tZ� 000n2 239-525 <br />R <br />MATT <br />everen <br />e <br />CANT RAL CON10.ACT0R MAIL ADD0.I55 <br />CITY ZIP iHONI lIC[NS[ <br />ZIP PHONE LICE NSI <br />K11CHAMCAL CONIRACIOR <br />MAIL ADOR[S$ CITY <br />PI,MB cCONI C10R MAIL ADDRESS CITY Glr •^�•• <br />17 sR � <br />CU6501 WORK <br />[]NEW ❑ADDITION ❑ALTERATION OffPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑ BUILDING RELOCATION <br />VAIUA]IONOI WORK <br />DIS(RIJII 11ORK n . d A. (•Q. _ A/I i� I.LC.[.'liR?I�•1� <br />EBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSI ttll 01 HL'II DING <br />I HE <br />AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PLICATION <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />u cm DF SCR) IION OF PRgpI RTY (SHOWN BLmW OR ATTACH IOU R corHsl <br />PROVISIONS <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />7 �.O <br />THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />Tj_lN <br />U BLOCK OF <br />OR NOT OF <br />TO VIOLATE OR CANCEL THE PROVISIONS <br />GIVE AUTHORITY <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />ANY OTHER <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAIUR[OF CONTI ACTOR OR AUTHORIZED AGENT DA1E��1_�- <br />/1 <br />ulx umxlss ` n/I ,(.J�LJti" �CItZ �TI <br />MECHANICAL <br />PLUMING <br />NO. TYPE OF EQUIPMENT FEE <br />NO, TY►E OF FITTURE <br />FEE <br />AIR CONE) UNITS —HP U <br />"Alfit CLOSET ITOLIETI <br />REFRIGERATION UNITS —HP EA <br />BATHTUB <br />HOIL[RS—HP EA <br />LAVATORY IW'ASM BASIN) <br />GAS fIRfD AC •UNITS —TONNAGE LA <br />SHOWfR <br />1 ORCFO AIR SYS7EM5—BTU M EA <br />KIICHIN SINK 8 UISP <br />ALl WALL ME ATIRS—BTU M <br />DISWASHER <br />UNIT HEALERS —BTU M <br />LAUNDRY TRAY <br />IVAPORAIIV[ COOLERS <br />CLOTHES WASHIR <br />CLOTHIS DRYERS <br />,v kU R HI AT ER <br />Vl NiIIATION FAN <br />URINAL <br />RANCE fwoD <br />DRINKING fOUN1AIN <br />AIR HANDLING UNIT— C F M <br />I IGOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />MI Ul I IR[ PI ACL A CHIMNEY <br />ROOF DRAINS —RAINI(ACT RS <br />SINK ISERVIC[—BAR. [IC) <br />STAR TOTAL S <br />SUB TOTAL <br />PERMIT S <br />PERMIT <br />f <br />TOTAL T[E s <br />TOTAL fIt <br />S <br />RUN YARD 51111 ACY <br />PLAN CHICK FEE <br />PLAN CHECK NUMB[R <br />SIDE YARD St IB.ACK Si Rf ET SL TRACK <br />FEE RECEIPT NO. <br />USE ZONE LOT AREA <br />VACANT SIZE <br />fits VALUATION HA <br />❑YES ONO <br />TYPE OF CONST OCCUPANCY CROUP <br />NO OF OWLILING UNITS <br />BUILDING S <br />SIZE OF BLDG NO OF STORI[5 <br />MAX OCC IOAU <br />PLUMBING <br />FIRE ZONE BASEMENT NI ):ROOM$ <br />REQUIREDSPRINKLERS <br />MECHANICAL <br />❑YES ONO <br />APPROVALS <br />RY DATE <br />OTHER <br />DEC <br />I ENVIRONMENTAL CHECK LIST <br />PINALTY SEC 30NR1 <br />2 BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />SYSTEM <br />PERMIT VALIDATION <br />VALIDATED YIN THIS SPACE) THIS IS YOUR PERMIT <br />I FIRE PROTLCIION <br />WHEN PROPERLY <br />5 GRADING4XCAVA7 ION& C IE ARINGIGRUBBINC. <br />6 DRAINAGE <br />7 I, IT, NMENTAL IMPACT STATEMENT <br />