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4 <br />r <br />APPLICATION FOR <br />FAR EYE,°IRlD Cl" DP CONSTRUCTION <br />everett PERMIT <br />DEPF OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.874S <br />r EVERETT. WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />0111IRO�c ",All ADORE <br />yU% j� tll, Zlr w1o: <br />l�re <br />ARrIun CI OR DESIGNER nqR ADORIS5 CITY ZIP rFCY,l <br />leleyzx! V51lF✓e y�) ['.e(. ��� y�.;/nsa�' fI j J', Mil t�FP,v(�a/ ycn-17�'s l✓2y - i�. Al <br />GINIRAI CONTRACTOR RIAIL ADDRESS CITY ZIP PHONE LICENSE <br />L <br />L <br />MECHANICAL CONTRACTOR MAIL ADDRESS CI1V ZIP PHONE LICENSER <br />PLUMBING CONTRACTOR MATE ADDRESS (ITS ZIP PHONE IICINfE1 Vi <br />CIA55 Of WORK ,,��// �-y / <br />❑NEW ❑ADDITION L14ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE LGSIGN ❑GARAGE ❑BUILDING RELOCATION <br />\'AIUAilON 01 NONM L� <br />' /y `�0 V <br />1 RIRI NUaI. / <br />%Jl � Inc /!i7✓(o 2� 1/</� /jll ✓i Sn 16i Al /.,2nv Z/a/rfn f/liti2i�i9z 1i&;✓ .401;,s1 e <br />raorosm USl of RUnol"(' <br />16 <br />I IIERL13Y CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO 13E TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL HE 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 CONTRACT R OR AUTHORIZED AGENT DATE <br />X�`� ram.._ f ri3 :5 'D .; <br />t(GAI DESCRIPTION DI PROPIRI, (SHOWN RHON OR ATTA( a FOUR CONE Si <br />l01 -BRIM, 01 <br />LG�d/�U�l/Y!/i �lt/LQLfT l 17�1 U <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />fit <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />SYAIIR CLOSET(1011171 <br />AIRCOND urvI1S-111' EA <br />BATHTUB <br />ITHRICIRATION UNITS -HP EA <br />LA%ATORYIWASH BASIN) <br />BONERS -HP [A <br />SHOW I R <br />GAS FIRED A C UNITS -TONNAGE (A <br />eITCHIN SINK A DISP <br />FORCED AIR SYSILMS-BTU MIA <br />DISWASHIR <br />NAIL IIIAIIRS-BTU M <br />IAUNDRS IRA) <br />UNIT HIATIRS--BTU M <br />110THIS SGASHIR <br />FVAPORATI\'1 COOLERS <br />N V T R HI ATI R <br />CLOTHE S ORYI RS <br />URINAL <br />\'1 NTIEATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I LOOR DRAIN <br />AIR HANDLING UNIT- C F AI <br />VACUUM BRIAKIRS <br />STCAI <br />ROOF DRAINS-RAINHADI RS <br />MI IAL IIREPLACI A CIIIMNES <br />SINK (SERVICE -TEAR. IT( I <br />SUBTOTAL <br />SUB TOTAL S <br />_ <br />PERMIT <br />f <br />PERMIT $ <br />TOTAL ELE <br />61 <br />TOTAL FEE S <br />SIDI S ARE) SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHICK TEE <br />RECEIPT NO <br />USE ZONE <br />101 AREA <br />VACANT SITE <br />❑YES ❑NO <br />FLE$ <br />VALUATION <br />FEE <br />TYPE Of CONST <br />OCCUPANCY GROUP <br />NO OI DWELLING UNITS <br />BUILDINGS <br />n % <br />IRti <br />SIZE OF BIDG <br />NO OF STORIES <br />MAX OCC TOAD <br />PIUMBING <br />FIRE ZONE <br />BASt A1ENT <br />III DROusY% <br />FIRE SPRINKIINS <br />REQUIRED <br />EIYFS LINO <br />%if I HANICAL <br />APPROVALS <br />BY <br />DATE <br />OIFUR <br />I ENVIRONMENTAL CHECK LIST <br />NI AIIY <br />UBC <br />SIC 1014) <br />Z BUILDING PLANS <br />TOTAL <br />1 TIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />S GRADINGII MCAVATION A CL URINGIGRUBBING <br />PERMIT VALIDATION <br />Wit N PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 IN\'IRONMINIAL IMPACT STATEMENT <br />A HIALTHDISTRICI <br />APPIICAIION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUA J�R <br />91-71) <br />J <br />L. <br />J <br />