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r- <br />L <br />APPLICATION FOR e7e evH <br />Me F.ergFBen cm of Y; ONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-874S <br />EVERETT, WA 98201 Mrnumm ATInBl n BUILDING ❑MECHANICAL ❑� PLUMBING PERMIT NO. <br />GLNIRAICONTRACIOR MAR ADDRESS CITY ZIP PHONE LICENSER <br />%.� LQw c'n�e -771-W7 <br />ME CHANICAL CONTRACTOR MAIL ADDRESS CITY LIP PHONE LICENSER <br />PUIMBING CONTRACTOK MAIL ADDRESS CITY ZIP PHONE LICENSE R <br />/tl ljell,. /3E/6 i1$ Ur. S.L. %829p 7JAZI/Y M0£44,020JA'7- <br />CLASS Of WORK <br />❑NCW ❑ADDITION ❑ALTERATION .REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑ BUILDING RELOCATION <br />WORK <br />Vnlllnl/�`10N Of <br />L ;z or <br />DESCRIBE WORK � <br />i _ // _ /. _,/ . _-,- /,._n! Ln.A cO n, <br />C C CI <br />PRo Sm USI Of BURDIND <br />LEGAL DESCRIPTION Of PROPLRTY(SHOW,l HDOWOR ATTACH FOUR COPRS) <br />LOT _BLOCK _OF <br />1 HEREBY CERTIFY TFiAT I HAVE READ AND EXAMINED T IS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING T HIS 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED GENT DATE <br />xr <br />JOB ADORE SS O <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />SVAIIN CLOSET(TOLIEH <br />AIR COND UNITS -HP LA <br />/ <br />13AIHTUR <br />00 <br />REIRIGERATILNUNITS-HP EA <br />/ <br />LAVATORY (WASH RASIM <br />HOILLRS-HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE [A <br />j <br />KITCHEN SINK B DISP <br />06 <br />FORCED AIR SYSTEMS-B T U M EA <br />DI>WASHER <br />WALL HEATERS -BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU AT <br />CLOTHS WASHER <br />U <br />I NAPORATIVE COOLERS <br />WATER MAIER <br />94 <br />L) <br />CIniNIS DRYERS <br />URINAL <br />CIN I ILAT ION FAN <br />DRINKING fOUNTAIN <br />RANGE HOOD <br />_ <br />I LOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF ORAIIIS-RAINLEADERS <br />A f LAE I IREPLACE A CHIMNEY <br />51NK (SERVICE -BAR, ETC 1 <br />-- <br />- <br />SUB TOTAL <br />,'J <br />O <br />SUB TOTAL % <br />PERMIT <br />S <br />OU <br />PERMIT 3 <br />, <br />TOTAL'EI <br />S <br />O <br />TOTAL <br />FEE <br />L <br />CHIC. FEE <br />RECEIPT IO, <br />SID[ YARDS[ I BACK <br />STREET Sf MUCK <br />REAR YARD SIIIIACX <br />PLAN UIICK Nk,%WIR <br />PLAN <br />Elf <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ❑NO <br />FLLS <br />VALUATION <br />FEE <br />TYPE OF CONS? <br />OCCUPANCY CROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />J <br />SIZE Of BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />/,i <br />a0 <br />FIRE ZONE <br />BASEMENT <br />BE DROOMS <br />INNKLERS <br />FIRE REQUIRED <br />YF5 ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHLR <br />1- <br />1 ENVIRONMENTAL CHECK LIST <br />— <br />PLNALIY <br />UJ3C <br />SEC JDJIaI <br />2 BUILDING PLANS <br />TOTAL <br />J FIR[ HYDRANT <br />R FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS 15 YOUR PERMIT <br />S GRADINGEXCAVATION A CI1 ARING I;RUBRING <br />5 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STAI1MINl <br />B. HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED 81 <br />011'R TOR ISSUANCE BY <br />91-79 <br />