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"" <br />cl111'n OF CONSTRUCTION LeoP <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-11745 <br />EVERETT. WA9R2D1 []COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT <br />MAII AU0RI55 l.Ill ZIP PNO4l <br />ANI <br />DER i.A-_A4u Z Q_ue4/_c— ) <br />ARCHITIC I OR UI 111.11e -- - -- <br />ZIP FIND IICINSI I <br />C11IRM CONTRACTOR MAII ADDRI SS <br />Clio <br />�IMLp SV.1J COQ P 72 M� 6'� �'S2"a° SI n4c eS c2 R <br />M1C11ANICA1 CONIRAC10R <br />MAl1 ADOR115 T Z <br />(IT, ZIP PHONE LICENSII <br />Pll'MBING CONIRACI00. MAIL ADDRESS <br />CL ASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE G.4 ❑GARAGE ❑BUILDING RELOCATION <br />1.LUAUON OF WORl <br />DnCRI i <br />rROYOStO USE OI BUILDING <br />LEGAL OESCRIPDON Of PROPERTY ISHOAN RIIOA OR ATTACH IOU0. COIIE51 <br />lot _ BLOCK _ Of <br />FOR ADDRESS <br />PLUMBING <br />OF <br />SHOWER <br />KITCHEN SINK & DISP <br />DISWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />-OAR. <br />SETBACK <br />ZONE tot <br />i OF CONS7 OCE <br />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 OTHLR STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Of C�AC&310R OR AUTHORIZED AGENT DATE 1 r L <br />FEE <br />SCK <br />BE YARD 5 <br />VACANT SIIE <br />OYES ONO <br />GROUP <br />NO Of EMIL <br />1[S <br />MAX OCC L( <br />111 DROO.MS <br />FIR[ SPRINK <br />REQUIRED <br />AMROVALS <br />1 ENVIRONMENTAL CHECK LIST <br />2 BUILDING PLANS <br />FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRADINGIE XCAVAI ION& CH ARINGIGRUBRING <br />& DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />& HEALTH DISTRICT <br />APPLICATION ACC BY 't,NS QLEGK ED BY <br />9 1-79 <br />BY <br />NO UNITS <br />LD <br />RS <br />DATE <br />BY <br />NO. <br />FEE <br />REFRIGERATION UNITS -HP EA <br />BOILERS -HP EA <br />GAS FIRED AC UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS -BTU M <br />WALL HEATERS -BTU M <br />UNIT MATLRS-BTU M <br />EVAPORATIVE COOLERS <br />VENTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNIT- C F M <br />510VE <br />METAL FIREPLACE & CHIMNEY <br />CHECK NUIMHLK -' - - <br />fE[ I RECEIPT NO. <br />BUILDING <br />S �- <br />PLUMBING <br />MECHANICAL <br />OIHER <br />URIC <br />PENALTY <br />SEC TDNa) <br />TOTAL <br />PERMIT VALIDATION <br />WHEN P ROPERLY VALIDATED (IN THIS S ACE) THIS IS YOUR PERMIT <br />✓I ��r <br />�e <br />LI'zVE/ <br />