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•NR Ewrp �Rn <br />OF <br />APPLICATION FOR <br />everett CONPERMITTIO1. <br />DEPT OF COMMUNITYDEVELOPMENT SERVICES <br />CITY HALL 259.6745 <br />EVERETT.WA98201 ❑COMBINATION ®.BUILDING <br />❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />OW'NIR \EMI ADOBISS <br />❑T, <br />ZIP <br />THOSE <br />r <br />��jj <br />4/ 11-SNSF7V ( s /!y C-'.Xdd/r7r <br />U., �"!/N , <br />�f �20� <br />)S 3 !S /1 <br />,/1A. <br />ARCHITECT OR DESIGNER AUIL ADDRESS <br />7 CITY <br />ZIP <br />PHONE <br />OENIRAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />PIUMBING CONTRACTOR MAIL ADDRESS CIE\ ZIP PHONE Ll(f N511 <br />CLASS Of WORK <br />®NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑PENCE []SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />\ :S G.?"— <br />DESCRIBE WORK <br />' Sr„.- <br />------------ <br />PROPOSEOUSE Of BUILDING <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 />SIGNATURE Of CONTRACTOR OR AUTHORIZED AGENT DATE <br />y _ �W •�Ga� <br />LEGAL DESCRIPTION Of PROPIRTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT _BLOCK_OF <br />_ <br />IOx AU11Pl •♦ _ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />It[ <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />S%MIR CLOSE7 (IOLIF71 <br />AIR CONE) UNITS-TI P I A <br />BAIHTUB <br />RIFRIGERATIONUNIIS-TIP IA <br />I AVATORY (W ASH BASIN) <br />BUILLRS-H P FA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KI7CHLN SINK A DISP <br />FORCED AIR SYSTEMS-B T U MIA <br />UISLVASHER <br />WALL HLATLRS-BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-BT U M <br />(U)THf S W%ASHI R <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />{ LOOK DRAIN <br />AIR HANDLING UNIT - C I AI <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS- RAINLFAMRS <br />ml TAL FIRFPLACE & CHIMNEY <br />SINK ISFRV'ICL-BAR ITC) <br />SUBTOTAL <br />SUBTOTAL E <br />PERMIT <br />S <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE R <br />SIDE YARD SETBACK <br />SIRE FT St TBACK <br />RE AR YARD SI IBACK <br />PUN' CHECK r.'UA196R <br />PLAN <br />111 <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT ARIA <br />VACANT SITE ' <br />OYES ONO <br />flt5 <br />VAIUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />BUILDING <br />L <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />TIRE ZONE <br />BASEMENT <br />III UBI)nMl <br />IFIRt REQUIRED INKLERS <br />OY[S ONO <br />MECHANICAL <br />APPROVAIF <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC ND(a) <br />Z BUILDING PLANS <br />TOTAL <br />1 FIRE HYDRANT <br />a FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT <br />S GRADING: I X(. AVAI ION& CIE ARINGICRUBBING <br />6 DRAIN.AGI <br />Z ENVIRONMENTAL IMPACT STATEMENT <br />B HIALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR TOR ISSUANCE BY <br />91-79 <br />