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EM EYeFprBBn <br />CITY OF <br />APPLICATION FOR <br />CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA982B1 ❑COMBINATION <br />OR OfSIG,ER <br />At <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING <br />lu I'll 71P <br />/V u IT <br />MAIL ADDRI51 <br />q <br />ZIP <br />PERMIT NO. <br />3s3_0;Nv <br />LICENSE R <br />PITMRI41 I ONTRACIOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />I IAll (11 WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE SIGN EIGARAGE ❑BUILDING RELOCATION <br />I\ 4 to VIA <br />I <br />Ill\I RINI WORI Al <br />PRIIPOSIDI%I OI Rwu]NI' <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 />X 1.1. �. <br />II(.AL DI SCRIPIION OF PROP)REV (SHOWN 8110W OR AT I ACH FOUR COPIES) <br />LOT—RIOCK—OF <br />R10 ADDRESS— <br />e fir'. <br />PLUMBING <br />MECH AL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WAII R CLOSE i TOM T) <br />AIRCONC UNITS —TIP IA <br />BATHTUB <br />REFRIGERAIION UNITS —HP EA <br />I AA'ATORY' (WASH BASIN) <br />BOILI RS—H P EA <br />SHOY'af R <br />GAS T IRI D A C :'N17S—IONNAGE [A <br />KIIOIINSWK A DISP <br />IOR(ID AIR SYSTEMS —BTU MEA <br />DISWASHIR <br />WAIT HIA7t RS—BTU M <br />LAUNDRY TRAY <br />UNIT HIATLRS—B7U M <br />(LOIHIS WASHIR <br />IS'APORATIVI COOLERS <br />WATER HEATER <br />CIOTIIIS DRYERS <br />URINAL <br />Vi NTIIATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I IOOR DRAIN <br />AIR IIANDI ING UNIT— C I M <br />VACUUM BRf AKI RS <br />STOVE <br />ROOF DRAINS — RAINLI AD[ AS <br />METAL FIREPLACE &CHIMNEY <br />SINK 1SFRVICI —BAR. ITC I <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT <br />f <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SI TRACK <br />STIFF II M TRACK <br />RI AR YARD SF IBACK <br />PLAN CHECK NUMBER <br />PLAN <br />Fit <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />IOF AREA <br />VACANT Slif <br />OYES ONO <br />FEES <br />VALUATION <br />Fit <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUIIDING <br />S <br />SIZE OF Bit)(. <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASIM(NT <br />❑IOROOMS <br />flRl SPRINKLERS <br />Rf QUIRED <br />Y[S fTNO <br />MICHANICAL <br />AP►ROVALS <br />BY <br />DATE <br />OTHER <br />1 [NVIRONMINUL CHECK LIST <br />PINAIIY <br />SIC <br />SIC 103Irl <br />NS <br />2 BUILDING PLANS <br />TOTAL <br />1 FARE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />ROPERLY <br />WI4ENf PV�.ALIDAILD (IN THIS SPACE) THIS 15 YOUR PERMIT <br />J <br />S GRADINGff XC AVATION A CLI ARINOGRURBING <br />A DRAINAGE <br />ENVIUL IMPACT STATEMENT <br />UDISTRICT <br />A MITH iH <br />APPLICATION ACC BY <br />�PPLAT%CE1✓EECK By <br />PPR�1054s5U 11EYj� <br />G(jA <br />9.1"19 <br />