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The Emgp r. APPt (CATION FOR <br />CITY OF COE .5TRUCTION <br />everett PERMIT <br />OF PT OF COMMUNITY DEVI LOPMI NT SERVICES <br />CITY HALL 259.8745 EVERETT, WA982D1 ❑COMBINATION E BUILDING El MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN R M111 AU11111 ]S .i�r car �n��a <br />! Av%- /! �XEbyLY Lr. t ,;�•^1C�2 c1 )G ? S 3 + y <br />GINERALCOSPRACTOR <br />MAILADDRESS <br />CIT] <br />ZIP PHONE <br />LICENSEE <br />CAA- "-I 't ti� <br />11 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE R <br />LICENSER <br />PIUMRING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />PNEW [—]ADDITION ❑ALTERATION ❑REPAIR ❑DENIOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />3 <br />OESCRI BE WORK ^ Y ♦ (/�� <br />ti . E -,;F-'Q <br />PROPOSED USE OI RUDINC <br />41e i "C- <br />I HEREBY CERTIFY THAT 1 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 TRACTOR OR AUTHORIZED AGENT DATE <br />" <br />OCAL Of SCRIP71O4 OF PROPFJt1Y1SHOWN BEIOWOR A17ACH FOUR COPIES) <br />JOE_FLOCK—OF <br />JOB ADDRESS <br />'Y/7- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />-- <br />14A7EH Cl05li li011l I <br />AIR COND UNITS —HP EA <br />HAIHTUB <br />RI FRIGE RATION UNITS —HP EA <br />LAVATORY DASH BASINI <br />"�1.Lt R5- N P EA <br />SNONER <br />GAS FIRED Ai UNITS —TONNAGE EA <br />KITCHEN SINK A OISP <br />IORCfD AIR SYSTEMS—B T U M I A <br />DISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRYTRAY <br />UNIT HEATERS —BTU M <br />CLOIMS W/.. R <br />I VAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />V1 NTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BRf AKERS <br />STOVE <br />- <br />ROOF DRAINS —RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (Sf RVICE—BAR. ETC) <br />19 <br />SUE TOTAL <br />I <br />SUN TOTAL 3 <br />PERMIT <br />si <br />PERMIT 3 <br />IOTA) FEE <br />3 <br />TOTAL FEE I <br />SIDE YARD SETBACK <br />STRIFT SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />',YES ❑NO <br />FEES <br />FEE <br />rVILIATIO- <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />SIZE OF tlLOG <br />NO CI 5*VRII S <br />AUX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />f1YIS [IND <br />MECHANICAL <br />- <br />�� APPROVALS <br />NY <br />DATE <br />OTHIR <br />1 ENVIRONMENTAL CHECKLIST <br />PI NAI IS <br />UFIC <br />SIC 30AW <br />_ <br />2 BUILDING PLANS <br />TOTAL <br />T {IRE HYDRANT <br />R I IRE PROTEi71ON SYSTEM <br />S GRADINGIL XCAYAT ION A CLI AP.INGIGRUBHI V C. <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE)THIS 15 YOUR PERMIT <br />6 DRAINAGE <br />7 'i NVIRONMENTAL IMPACT 57MEMINT <br />6 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />91-79 <br />