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APP! (CATION FOR <br />CuNSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />f ITV HALI 7XQA7A5 <br />crcrcn <br />e <br />OWNER I� <br />Veer f\r�d 3 <br />MAIL ADDRISS <br />i�oL V;;ram;. �:4 <br />(Ih <br />Even# <br />ZIP <br />9¢'z47/ <br />PHONE <br />:;z. <br />ARCHITECT OR DESIGNER <br />MAII ADDRI SS <br />IHI <br />ZIP <br />PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />[]NEW❑ADDITION ❑ALTERATION REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUAI NOF WORK <br />F f50r <br />DESCRIBE WOPK <br />PROPOSED USE OF RUIIDING <br />✓�.f..rF/!1 �rT: i'/:F <br />LEGAL DLSC TION Off IRTY ISHO y LOW OR Al1ACfl� U`R� fOPlfsl <br />p19-3a �_ ,;RC <br />Lo PIOCK 3 oI <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 />A 1 <br />— <br />FOB ADDRE�SS <br />c7.,lir—rtL <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSLT (TOLIETI <br />AIR CONE. UNITS-11 P 1 A <br />BATHTUB <br />REFRIGERATION UNITS —lit' IA <br />I AVATORY (WASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />CAS FIRED AC UNITS—TONNACL[A <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. MIA <br />DISWASHER <br />WALL HEATf RS—BTU. AVE <br />-- <br />LAUNDRY TRAY <br />UNIT HEATERS— B.T U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M. <br />VACUUM BREAKERS <br />710X1 <br />ROOF DRAINS -- RA' ALF ACf RS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE —BAR, ITC 1 <br />— <br />i <br />STIR TOTAL <br />SUB TOTAL S <br />PIRMIT <br />$ <br />PERMIT S <br />TOTALIFt <br />$ <br />TOTAL EEL S <br />SIDE YARD SETBACK <br />S1 RIII SI IHMk <br />REAR YARD SETBACK <br />VI AN CHECK N(IMIII R <br />PI AN <br />III <br />CHECK FEE <br />RECEIPT NO. <br />USE ZON[ <br />I OT ARIA <br />VACANT SITE <br />OYES ONCE <br />TIES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG, <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />CYFS ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECKLIST <br />— <br />PENALTY <br />U.B.C. <br />SEC. ]E07(a) <br />2. BUILDING PLANS <br />TOTAL <br />7. FIRE HYDRANT <br />I. FIRE PROTECTION SYSTEM <br />-- <br />PERMIT VALIDATION <br />WIT N PROPERLY VAL IDATE 0(1N THI5 SPA CIE) THIS IS YOUR PERMIT <br />i. URADINGIEXCAVATION A CLEARINGIGRUBNINI: <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />6. HEALTH DISTRICT <br />APPO( A11ON AN ILA <br />