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FAR EYBrpr"n <br />C.!Y OF <br />APPLICATION FOR <br />%.CONSTRUCTION <br />everett PERMIT <br />DEPT Or COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2598745 <br />EVERETT, WA 98201 ❑COMBINATION JK BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDRESS ❑1Y ZIP PHONE <br />qj M Eper- trrJy °G A 3SS -//90 <br />ARCHITECT OR 015IGNIR MAIL ADDRESS CITY ZIP PHONE <br />GENIRAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />IICENSEI <br />O b✓ n-.'F4 <br />MECHANICAL CO%TRAC1OK <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSEE <br />PIDMBINC CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 1 <br />It AM OF WORK rTtytT <br />❑NEW ❑ADD!TION ❑ALTERATION XREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />lMly{�gIION OI WORK <br />DI S`RIBf WORK <br />r��rcN c <br />PROPOSED Ua of BwIDrvG <br />)j��•A <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 GF 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 />LEGAL of scrlPDoN of PROP)RIY ISH WN A W OR ATTACH IOUR OPBsl <br />�� % / I <br />loll: ! BLOCK a" Or + <br />�R� <br />ION ADDRI SS-77 <br />PLUMBING <br />'MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET LIOLIED <br />AIR COND UNITS—H P EA <br />BATHTUB <br />REFRIGERATION UNITS —HP EA <br />LAVATORY IW ASH BASIN) <br />BC: ERS—H P [A <br />SHOWER <br />GAS FIRED AC UNHS—TONNAGE EA <br />KITCHEN SINK & DISP <br />IORCI D AIR SYSTEMS-0 T U M EA <br />DISWASHFR <br />WALL HEATERS-9IU M <br />LAUNDRY TRAY <br />UNIT HLAIIRS—B T U M <br />CLOTHES WASHER <br />tVAPORAIIVE COOLERS <br />WATER HIAIER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />IHHNKING FOUNTAIN <br />RANGE HOOD <br />ILOOR DRAIN <br />AIR HANDLING UNIT— CFM <br />VACUU'L BREAKERS <br />SIOYf <br />ROOF DRAINS —RAINLI ADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SI RVICt —BAR, ETC) <br />SUB TOTAL <br />I <br />SUIT TOTAL S <br />PERMIT <br />51 <br />PERMIT S <br />TOTAL FEE <br />IF <br />I <br />TOTAL FEE S <br />SIDE YARD SI111ACK <br />STREET SETBACK <br />BEAK YARD St TBACK <br />PLAN CHECK NLnABIR <br />PLAN <br />IEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />/F[S <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO Or DWELLING UNITS <br />BUILDING <br />S <br />SIZE c• BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEN.:NT <br />III DROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />CYIS ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />URC <br />SEC lURal <br />2 BUILDING PENS <br />TOTAL <br />A FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />S GRADINGI: XCAVAT ION & CLI AR INGIGRUBRING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKID BY <br />APPR FOR ISSUANCE BY <br />