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APF (CATION FOR W <br />CITITY OF EWEprIID CONSTRUCTION <br />C <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT• WA98201 ❑COMBINATION ❑ BUILDING <br />❑MECHANIC_AL <br />❑PLUMBING <br />PERMIT NO. <br />OWNER MAIL AUDKI55 <br />LYTy :P E✓ERETj ury 1,4fLj_ <br />CIT1 <br />EvAE�.ce77 <br />ZIP <br />9B2a/ <br />PHONE <br />25`)-e70/ <br />ARCHITECT OR DESILNLR MAIL ADDRESS <br />r/re 6e4,r1CS7 <br />CITY <br />B✓EXI677 <br />ZIP <br />91620/ <br />PHONE <br />257-5557 <br />GENIRALCONIRACIOR MAIL ADDRESS CITY ZIP PHONE ZI�NfSEIIT <br />P.t'OSECTS l✓.✓UAI/7ED,TiT/�• /L'a/�j Xo &wcoz> A✓E. EVee57T •7�0¢ :.�'L'h�355So/O _E= goof <br />MAIL <br />PLUMBING CONTRACTOR MAIL ADDRESS Cln ZIP PHONE LICENSER <br />CLASS Of MORK <br />®NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN []GARAGE ❑BUILDING RELOCATION <br />VALUATION Of W RK eu <br />IF 3990¢ <br />DE5CRIBE WORK <br />.. oi�.Rv <uci r<n f ACFA L/6N TS <br />,.w W✓v r <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF P40PEWIY ISMOWN BELOW OR ATTACH LOUR COPIES) <br />LOT —BLOCK —OF _ <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 CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />O 80 <br />X61, <br />JOB ACCUSE A <br />'owc4e. Pce - �605 So. 3ieD ✓r VL„ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. I <br />TYPE OF EQUIPMENT <br />FEE <br />\\'ATER C105LT IIOLIETI <br />I <br />AIR COND UNITS-H P EA <br />BATHTUB <br />REFRIGERATION UNITS -HP [A <br />I AVAIORY(WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GASIIREDAC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-BT U M EA <br />UISWASHER <br />WALL HEATERS -BTU AS <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU M <br />CLOTHES WASHER <br />I\'APORATIVE COOLERS <br />WAI[R HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />1IOOR GRAIN <br />AIR HANDLING L'NIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLE ADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC I <br />!'T <br />SUBTOTAL <br />TOTAL f <br />PERMIT <br />f <br />f <br />_ <br />TOTAL FEE <br />S <br />f <br />TOTAL fitCHECK <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLA�ECK NUMBER <br />8Irm <br />FEEL 0 N <br />RECEIPTENO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />VALUATIO`. <br />FEE <br />TYPE �Of CONST <br />/ ,N <br />OCCUPANCY GROUP <br />A - <br />NO OF DWELLING UNITS <br />BURDINC <br />n <br />f O <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />aG <br />FIRE ZONE <br />BASEMENT <br />BIDROOMS <br />'— <br />FIRE SPRINKLERS <br />REQUIRED <br />".YTS XNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />URC <br />SEC 201(I) <br />2 BUILDING PLANS <br />TOTAL <br />�^ <br />FLEE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED JIN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION&CLEARINGIGRUBBINC <br />6 DRAINAGE _ <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />_ <br />APPLICATION ACC BY <br />I PLANS CHECKED BY <br />APPR FOR ISSUANCE By <br />9.1 79 <br />