Laserfiche WebLink
APP! (CATION FOR PYPTPH <br />CuNSTRUCTION e everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 rtrt11 -- - - - <br />EVERETT.W'A98201 COMBINATION DO BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER VV MAIL ADDRISS IITY ZIP Pit(),[ <br />pe r 4�rctI✓� c�t0/i (/%ro;rl;a f7ereIt '71M42/ >,�>`-Y��� <br />ARC1117ICT OR DESIGNER MAIL ADDRISS ( 11) ZIP PHONE <br />­m.L nuunuo I'll ZIP PHONE LICENSE <br />:5Qtr-re <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PIIONf LICENSEI <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION VREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUAT NOF WORK <br />36O <br />DESCRIBE WORK <br />�,ayodaT�ITty -I- 11--ov <br />raerosfD USE or Bmml"c <br />. .� <br />I HERERY CERTIFY THAT I HAVE RI7.D AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINA 4CES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 10 <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 />y <br />A <br />ucAL u[sc DON of P fRTV ESHo EOW o, a/A�TTACH ua coPHsl <br />Eot'19'30 BEocK�or tom/ � - /7 <br />JOB ADDRISS <br />11✓'/ <br />PLUMBING <br />.MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CIOSET ITOI.JETI <br />AIR CONO UNITS-11. P. EA <br />BATHTUB <br />.HURIGERATION UNITS-11 P I <br />LAVATORY (SVASII BASIN) <br />BOILERS-H P EA <br />SHOWER <br />GAS FIRED A.C. UN175-TONNAGE [A <br />K17ZHEN SINK A DISP <br />IORCED AIR SYSTEMS-B T.U. M 1 A <br />D15W'ASIIIR <br />WALL HEAILRS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B. TU M <br />CLOTHES WASHER <br />IVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VI NTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I LOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOFDRAINS -RAINLFADI RS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FLE <br />S <br />TOTAL FEL 3 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />111 <br />CHICK FEE <br />RECEIPT NO, <br />USE ZONE <br />LOT AREA <br />VACANT SITk <br />;AIS ONO <br />FEES <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 />EEL GROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />I11'(S FIN ) <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. INVIRONMLNTAL CHI CE: LIST <br />IF NALiI' <br />VOC. <br />SEC. 3031A) <br />2, BUILDING PLANS <br />3. FIRE HYDRANT <br />TOTAL <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THI5 15 YOUR PERMIT <br />S GRADINGIf %UVATION A CLI ARINGIGRUIIBISI. <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE Lit <br />9179 <br />