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the EnfOrW <br />CITY OF <br />APPLICATION FOR <br />.,ONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELCIPPAi NT SERVICES <br />CITY HALL 259-8745 <br />EVEV�TT. WA98201 ❑COMBINATION BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MMl AOUMI II CIl) PHONE <br />ZIP <br />GINERAL CONTRACTOR MAIL ADDRESS CITY Lp PHONE LICFNS[ IF <br />O c:, n. f/( <br />MICHANICM(ON TRACTOR MAR ADDRESS CITY LIP PHONE TIC WSER <br />CIl) 21P PHONE LICE NSF <br />PLUMBING CONTRACTOR MAII ADDR[SS <br />CLASS OF WORK rTt�Tf <br />❑NEW ❑ADDITION DALTERATION VUREPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE 0BUILDING RELOCATION <br />V ON OF WORK <br />DISCRIBF WORK <br />PROVOST D USE OI <br />LtCAT DESCRIPTION Of PROPS RTY I1N,.WN BEL� OR ATTACH <br />l0T 1q <br />.11 BIOCt Of " I", <br />JOB ADDRESS <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP, <br />PLICATION AND KNOW THE SAML 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 />✓!/l //1/4!/!,5/5 <br />/1 <br />PLUMBING ' <br />ECHANICAI <br />'ENT <br />FEE <br />FEE <br />NO. <br />TYPE OF EQU' <br />NO. <br />TYPE OF FIXTURE <br />AIR COND UNITS-H P EA <br />WATER CLOSET ITOIIE TI <br />REFRIGERATION UNIT$-N P EA <br />BATHTUB <br />BOILERS -HP EA <br />LAVATORY (WASH BASIN) <br />GAS FIRED AC UNITS -TONNAGE FA <br />SHOWER <br />I ORCI O AIR SYSIF MS-N T U M EA <br />KITCHEN SINK A D15P <br />1VALL. NF ATE RS-N 7 U M <br />DISWASHI R <br />UNIT Mf ATI RS-N i U M <br />LAUNDRY TRAY <br />F \'APORAiIVE COOLERS <br />CLOTHE5 WASHER <br />CLOTHES DRYERS <br />WATER HIATLR <br />VENTILATION FAN <br />URINAL <br />HOOD <br />DRINKING FOUNTAIN <br />MR H ANDL'NG UNIT- C F M <br />AIR <br />FLOOR DRAIN <br />SIOVE <br />VACUUM BREAKERS <br />MIiAI IIRIPUC! 6 CHIMNEY <br />ROOF DRAINS- RAINLI ADLRS <br />SINK (SERVICE -BAR. ETC] <br />SUB TOTAL B <br />-- <br />SUB TOTAL <br />PERMIT B <br />PERMIT S <br />B <br />S <br />TOTAL FEE <br />TOTAL FEE <br />STREITS[TBACK REAR YARD SI TBACK <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />SIDE YARD St TRACK <br />fFE RECEIPT NO <br />USE ZONE <br />VACANT SIT! <br />FEES <br />VALUATION <br />FEE <br />❑YFS ONO <br />TYPE OF CONS? <br />ELOTREA <br />UPANCY GROUP]NO <br />OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAR OCC LOAD <br />PLUMBING <br />{IR[ ZONL <br />BASEMENT <br />IIt URJOMi <br />HILL SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />CYFS ❑NO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENV!RONMENTALCHICK LIST <br />PI NAli1' <br />UPC <br />C Tm(.) <br />2 BUILDING PLANS <br />TOTAL <br />FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADING'IKCAVATIONACLl ARINGIGRUBBING <br />B DRAINAGE <br />7 ENVIRONMENTAL IMPACT','AHMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9-179 <br />