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APPLICATION FOR, �YNPN„ <br />CITEF <br />cCITYOof CiNSTRUCTION <br />everetr PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2S9-A745 <br />EVERETT. Y%A98201 nfn URENATIDIN ❑BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />GINf RAI CONTRACTOR MAIL ADD' "SS CITY ZIP PHONE LICENSEE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS City ZIP PHONE LICENSE <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR QOEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑PUILDING RELOCATION <br />VAIVAI ION OF WO <br />S <br />DESCRIBE WORK <br />O <br />BENS. XL II S A. I <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME 10 BE TRUL 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 <br />/OOFFCONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />MLCHANICAL <br />LEGAL D[SCRIPTIONOF PROPLRIYISHOWN BILOWOR ATTACH IOURCOPIESI <br />LOT _ BLOCK —OF <br />l 1 <br />108 ADDRESS (� (Ti <br />I OD cC , I '.o, 1�J�-1 ° <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />Ft[ <br />NO. <br />TY►E OF EQUIPMENT <br />FEE <br />WATER CI05I7 POLIET) <br />AIR (ONO UNITS-11F [A <br />BAIHIUB <br />R If RIGIRAIIONUNITS-HP [A <br />LAVATORY (WASH BASIN) <br />BOILIRS-HP [A <br />SHOSV(R <br />WS IFEEL D AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCE D AIR SYSTFMS-BTU MIA <br />DISWASH1R <br />"ALL HEATERS--B 1 U M <br />LAUNDRY TRAY <br />UNIT HHAIERS-B I U M <br />CLOTHES WASHER <br />I% APORATIVL COOLERS <br />WAI[R HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION IAN <br />DRINKING, FOUNTAIN <br />RANGE HOOD <br />I IOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM FIRE AKIRS <br />STOVE <br />ROOF DRAINS -RAIN _!A)(RS <br />MI TAL fIREPLACI A CHIMNEY <br />SINK (5ERVICE -BAR. TIC) <br />SUN TOTAL <br />SUBTOTAL B <br />PERMIT <br />S <br />PERMIT B <br />TOTAL Fit <br />IF <br />TOTAL FEE B <br />SIDF YARD$[TRACK <br />SIR[IT SETBACK <br />RUR YARD SETBACK <br />PUN CHIC K':UMBLR <br />PLAN <br />LEI <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT ARIA <br />VACANT SITE <br />DYES ONO <br />TIES <br />VALUATION <br />Fit <br />TYPE Of CONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />BUILDING <br />S <br />SIZE OT BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIR[ ZONE <br />RASEMENI <br />IIk URO(7M5 <br />FIRE SREDKHRSREQUI <br />DYES ONO <br />ML GHANIGAL <br />-- <br />A►PRCVAIS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />FINAL" <br />U BC <br />SEC 303(A) <br />2 BUILDING PLANS <br />TOTAL <br />l IIR[ HYDRANT <br />I TIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGIL XCAVAT ION& C IT ARINGIGRUBRING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9.1 79 <br />