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E„BEmgTooD A "PLICATION FOR �YBT�e <br />CITY CF ONSTRUCTION <br />everett PERMITL- <br />D£PT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-R745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS <br />arr zip PHONE <br />r, <br />l_ 'u <br />ARCHITECT OR DISIGNOL MAIL ADDR[55 CITY ZIP PHONE <br />❑INERAICONIRACTOR MAIL ADDRESS CITY ZIP PHONE <br />IICINS[ 1 <br />, {✓Li: 7 L <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LFCENSFI <br />CLASS OI'VORK <br />ENEW []ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN GARAGE ❑BUILDING RELOCATION <br />S <br />of <br />PROPOSED USE OF BUILDING <br />S J ✓: t: r-�' GA% n✓ �` .S Y' — <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT NLL <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 />SIf,NATURI OF CONTRACTOR OR AUTHORIZED A(ENT DATE <br />/� ) •rf.�. <br />�I� Io - �•^ - V. <br />FICA[ DESCRIPTION OF PROPUTYLSHOWN BELOW OR AIIACH FOU coon 51 <br />�b �� <br />lol-1y_BLIXK -3�oF TI E it" r—!� �r <br />CrC+ 1 >/ (1 <br />IOB ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />SYATIR CLOSET 11011111 <br />AIR CONE) UNITS-14P [A <br />BATFITUB <br />R[FRIGLRA71ONUNIIS-HP LA <br />IAVA'IORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWlF <br />CAS HRED AC UNITS -TONNAGE EA <br />KITCHEN SINK 6 DISP <br />FORCED AIR SYSTEMS-B T U MIA <br />DISWASHLR <br />WALL HIATERS-B(U M <br />LAUNDRY TRAY <br />L.NU HFAIIRS-B T U M <br />CLOTHES WASHER <br />IAAPURATIV[ COOLERS <br />WATER HEATIR <br />CI OIHES DRYERS <br />URINAL <br />VI NTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C E M <br />VACUUM BREAKERS <br />SIOVf <br />ROOF DRAINS-RAINL [ AD[ RS <br />MI T AI I IRI P[AC 1 B CHIMNI Y <br />SINK )SERVICE-RAR, FTC 1 <br />I <br />SUB TOTAL <br />SUB TOTAL { <br />PERMIT <br />! <br />PERMIT { <br />TOTAI FEE <br />S <br />TOTAL FEE { <br />SIDE YARD SETBACK <br />STRIIT SLIBACK <br />RI AR YARD St ILIA( K <br />PIAN CHECK NUMBER <br />PLAN <br />IFI 3 <br />CHECK FEE <br />RECEIPT NO. <br />'S'� Ll <br />USE ZONE <br />LOT ARE <br />� <br />L`iL F 1, <br />� •1i� •may' <br />VACANT SITE <br />OYES ONO <br />TEES <br />VALUATION <br />FEE <br />TYPE OF CON5T <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />BUILDING <br />- <br />•'�Y <br />SIZE OF BLDG <br />3 .. E y 1 A <br />ND OF STORIES <br />IF,< <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONi <br />- <br />BASEMENT <br />— <br />I BIDROOMS <br />FIRE SPRINKLERS <br />REQUIRED/ <br />nYEs rWo <br />MECHANICAL <br />APPROVALS <br />{'/ <br />DAT[ <br />OTHER <br />I ENVIRONMENTAL CH[( K I ISI <br />PENALTY <br />UBC <br />SEC 1011A1 <br />2 BUILDING PUNS <br />TOTAL <br />...777 ��- <br />1 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHIN PRCPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />/ <br />S GRADING! XC AVATION A CLL ARINGrGRUBflING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />6 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />I <br />9 1-79 <br />