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ERN EPNPENB APPLICATION FOR CITY OF CONSTRUCTION 0 <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-9745 <br />EVERETT, WA9R201 DCOMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER .ALL ADI1KI55 CITY ZIP PHONE <br />420 2 R-v�-4) Tarim <br />MAIL ADDRESS Lily ZIP PHONE <br />GIATRAI CONTRACWR ���MAIL ADDRESS CITY ZIP PH <br />D' : LICENSE IF <br />C�IML� Sl(� 66R-p . "72'IT"i MAP(E SI MC OS <br />CONTRACTOR <br />PLUMPING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE GN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORD <br />PROPOSED USE OF PUILDING <br />LEGAL ,Sr i OF PROPIRTY )SNOW N BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCR__Of <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 />MCNATI IRE OF CQKNIAC}OR OR AUTHORIZED AGENT DATE K <br />X <br />JOB ADDRESS <br />IZ I <br />C <br />ANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO, <br />TYPE OF FIXTURE <br />WATER CLOSET ITOIIFT) <br />AIR COND UNITS-H P EA <br />REFRIGERATION UNITS -HP EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />GAS FIRED AC UNITS -TONNAGE EA <br />SHOWER <br />ICIII AIR SYSTEMS-B T U MIA, <br />KITCHEN SINK A DISP <br />WAIL HEATERS -BTU M <br />OISWASHER <br />UNIT Hf ATI RS-ATV AS <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />WATER HE ATIR <br />CLOTHES DRYERS <br />VINTILATION FAN <br />URINAL <br />DRINi ING FOUNTAIN <br />RANCE HOOD <br />AIR HANDLING UNIT- C F M <br />FLOOR DRAIN <br />V/.000M BREAKERS <br />STOVE <br />MITAI TIRE PLACE 6 CHIMNEY <br />ROOF DRAINS-RAINLEADIRS <br />SINK (SF RVICI - BAR IICI <br />SUN TOTAL / <br />SUN TOTAL <br />PERMIT / <br />PERMIT <br />/ <br />/ <br />/ <br />TOTAL FEE <br />TOTALIFF <br />SIDE YARD SETBACK SiR[[1 SCTPACK <br />REAR YARD SETBACK <br />PLAN CII[CK NUMBER PLAN CHECK <br />Ff[ RECEIPTT NO. <br />US[ ZONE <br />LOT ARIA <br />VACANT SITE <br />IF[% <br />VALUATION <br />Fit <br />E]YES CNO <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S 1 �. <br />SIZE OF BLDG <br />NO -OFF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />❑I PNIN>M! <br />Rf QUIRIIUKLfRS <br />MICFIAMCAL <br />'''YES .':NO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHECK LIST <br />PENALTY <br />VBC <br />..r 303(A) <br />7 BUILDING PLANS <br />TOTAL <br />C <br />3 FIR( HYDRANT <br />A FIR[ PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WIZEN PROPERLY VALIDATED (IN THIS S ACE) THIS IS YOUR PERMIT <br />S GRADINC'1XCAVAIIONFCLIARING'GRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENIALIMPACTSIAIIMINT <br />