Laserfiche WebLink
EDB EmrgmO A °PLICATION FOP <br />CITY OF :ONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER -_ MAIL ADDRESS ;wSLLO G1� CITY tiP P1101I <br />6nY(-•j C'LtE tLE/ u)aa' '( <br />ARCHITECT OR OESIDNtR MAIL ADDRESS CITY ZIP PHONE <br />GI MRAI CONTRACTOR <br />(Mb lL Cc: R2 <br />MA;L ADDRESS <br />2�fi MMI.o <br />CITY <br />CY.'vk;'� gib z: <br />ZIP PHONE <br />vki. <br />LICENSEP <br />C- <br />Z1 Z-U SI•nAc -<`i <br />t_L•i Z-r> <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />LIP PHONE <br />_ <br />LICENSE I <br />PIUMRING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE IICENSU <br />CLASSOF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR []DEMOLITION ❑FENCE ®SIGN ❑GARAGE ❑Bull nlNr Rn nr.TlnN <br />DESCRIBE WORK ( " <br />PROPOSED USF OF RUILOINC <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUL 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 OT: IER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />/ - <br />O� <br />FECAL DISCRIPTIONOF PROPERTY ISNOWN BELOW OR ATIACHIOUR COPIISI <br />Tor _BLocK_or <br />JOB ADORE SS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYRE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />W A I E R CLOSE T I TOL I I T I <br />AIRCOND UN11S-HP IA <br />HATIOUB <br />RE FRIGERAlJON UNITS - HP EA <br />Al' TORS (%'ASH BASIN( <br />ROVERS -HP IA <br />5110NIR <br />UASFIRED AC UNITS -TONNAGE F, <br />KITCHEN SINK A DISP <br />I ORCI D AIR SSS TEATS - RID MLA <br />DISW'ASHIR <br />WALL TIE ATERS-BTU M <br />LAUNDRY 1RA7 <br />UNIT HIATERS-B T U M <br />CLOTIH S 15'ASHI R <br />F\'APORAIIVL COOLERS <br />SAAIIR MAIER <br />CLOTHES DRYERS <br />URI%AL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />1IOOR DRAIN <br />_ <br />AIR HANDLING UNIT- CFM <br />ACUUM BREAKERS <br />STOVE <br />ROOr DRAINS-RAINIFADERS <br />METAL FIREPtAC1 A CHIMNEY <br />SINK (SERVICE -BAR. It( 1 <br />SUBTOTAL <br />SUR TOTAL { <br />PERMIT S <br />PERMIT { <br />TOTAL FEE 61 <br />TOTAL FEL { <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SI TBACK <br />PLAN CHECK NUMBER <br />PLAN <br />111 <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SI1E <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BIDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />TIE GROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑Yfs CNO <br />MECHANICAL <br />APPROVALS <br />RY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />B C <br />SEC FORT) <br />2 BUILDING PLANS <br />B FIRE HYDRANT <br />TOTAL <br />. TIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />W HI N PROP( RLY VAIIDA DINT S SPACE) THIS 15 YOUR PERMIT <br />I `mil <br />I�1 Un„I �... <br />44`;h_ - <br />Y�'�•+ /r[�(/ ©,C/ �iO IG ,��•��'P N"W <br />5 GRADINGIEKCAVATION&CLEARINGIGRURRING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE R1 <br />911-9 <br />