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Ow Ewgrvmfo� APPLICATION FOR <br />everett CONSTRUCTION <br />cm of evercn <br />IT <br />DE PT OF COMMUNITY DI.VEIOPME NT SERVICCS <br />CITY HALL 2598775 <br />EVERITT, WA 98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />1777/ \II NUIINI'S IIIY ),IP PHONE <br />-RINnIr I UR DI SICNI R <br />MAG ADORII'S CITY <br />ZIP <br />PHONE <br />L/ <br />/,t;,�y% <br />3s <br />Cl/NIRAI ONIRACIUR <br />ApOR1 f5 CITY <br />ZIP <br />PHONE <br />IICINSI I <br />/,M/A/JH <br />\IIf 11AYl(M CONIRACtOR <br />MAIL ADORE IS OTY <br />ZIP <br />PHONE <br />LICINSLI <br />PII'\IRING(ONTRAC TOR <br />MAH ADDRHS (OY <br />ZIP <br />PHONE <br />LICINSEI <br />CI ASS OI WORK <br />❑NEW ❑ADDITION <br />❑ALTERATION <br />❑REP.AIR ❑DEMOLITION ❑FENCE <br />SIGN <br />❑GARAGE ❑BUILDING <br />RELOCATION <br />t via <br />i ✓:'� r t! <br />111\I WILL WaR\ <br />))�q <br />rROPOSID USE Of wnmN(, <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 />SIGNAIURL OI CONTRACTOR OR AUTHORIZED AGENT DATE <br />/ I <br />1IC41 DIWITIPTION Of PROPERTY ISHOAS RIIONOR ATTACH FOUR COPIES) <br />IO] _RIOCK_Of <br />ulR SPDRIII s <br />PLUMBING <br />MECM AL <br />NO. <br />TYPE OF FIXTURE <br />FJ <br />NO. <br />TYPE OF EQVI►MENT <br />FEE <br />WATER CLOSE T (TOLIFT) <br />AIRCOND UNITS -HP IA <br />BATHTUB <br />RHRIGERATION UNITS -HP EA <br />IAVATORVVAASHFASIN) <br />BOILERS -HP EA <br />SHOW I R <br />GAS FIR(t) AC UNITS -TONNAGE EA <br />KIICHIN SINK A DISP <br />IORCI D AIR SYSIIMS-H T U ME <br />DISWASHIR <br />WAIT HIAIIRS-81U M <br />IAIINDRY TRAY <br />UNIT IIIATIRS-67 U M <br />(IOIHES WASHIR <br />IVAPORATIVI COOLERS <br />W ATER HIATIR <br />CIOTHIS DRYIRS <br />URINAL <br />VI NTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CFM <br />%A( UUM BRI AKE IRS <br />Slow <br />ROOF DRAINS-RAINLE AD'RS <br />— <br />METAL FIREPLACE S CHIMNEY <br />SINK(SERVICE -BAR ITC) <br />SUB TOTAL <br />SUBTOTAL F <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />RI AR YARD SI TRACK <br />PLAN CHECK NUMBER <br />PLAN <br />If[ <br />CHECK FEE <br />RECEIPT NO <br />I/SE ZONE <br />101 AREA <br />VACANT SHE <br />DYES CNG <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONS7 <br />OCCUPANCY GROUP <br />NO OF DWHLING UNITS <br />BUILDING <br />S <br />SIZE OF BIDG <br />NO OF STORIES <br />MAX OCC IGAO <br />NUMBING <br />IIRI ZGNF <br />BASFMEN7 <br />lit HROOMS <br />IIRI SPRINKLERS <br />REQUIRED <br />CYIS FIND <br />ME CIIANICAL <br />APPKOVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL Cl/LCK LIST <br />PINAITY <br />URIC <br />SIC lO.NR) <br />Z BUII DING PLANS <br />1 FIRE HYDRANT <br />TOTAL <br />I FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR >PERMIT <br />�j' /.�7 �., _�E` A._✓ <br />�� <br />5 GRAOING'1 X( AVAIION A C H ARINGIGRUBBING <br />6 DRAINAGE <br />7 FNVI<ONMENTAL IMPACT STATEMENT <br />R HIAIIH DISTRICT <br />