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APPLICATION FOR <br />CITYOFthe "° CONSTRUCTION `P 1 <br />ln <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259"8745 <br />EVERETT. WA98201 ❑COMBINATION ❑ BUILDING ®MECHANICAL ❑PLUMBING PERMIT NO. <br />OWN,R MAIL ADDRISS CIT1 ZIP rhos! <br />r <br />ARCHITECT OR Dl SIGNlR MAIL ADDRESS UIY ZIP PHONE <br />CENTRAL CONTRACTOR MAIL ADDRESS CM ZIP PHONE LICENSE F <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE I LICENSE IF <br />GJ 45I7 FYI s TvA.) 1t t7ufem L Ct cr <--t/c- _/EfrTT 353 -333% <br />PWMOISI: CONTRACTOR MAIL IDDRl SS (I" ZIP PHONE LICLNSIP <br />CL ASS OF WORK Iy <br />❑NEW ❑ADDITION NALTERATION ❑REPAIR ❑DEMOLITION OUNCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />DESCRIBE WORK / A <br />reorauD usl a I+uDDINC <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 />PROV'15IONS OF LAWS AND JRDINANCES 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 INSTRUCTION. <br />SIGNAT F CONTRACTOR OR UTIIORIZID ACENT DATE <br />3-/7-d`3 <br />LEGAL DISCRIPTIONOF PROPERTY (SHOWN FIDOW OR ATTACH FOUR CORTESE <br />tM BE OCK_OF <br />1011 AU'JPIX <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />W%AEI R CLOSE I(TOLIf T) <br />AIR CONE UNI1S-1IP IA <br />SATHIUB <br />ITHRICARAIIONUNITS-TIP IA <br />LAVAIORY IWASH HASINI <br />HOILIRS-TIP [A <br />910AIN <br />GAS IIRIDAC UNITS-IONNACLEA <br />KITCHEN SINK A DISP <br />IORCTD AIR SYSTEMS-B T U MLA <br />DISWASHLR <br />WALL HIAURS-IIIU M <br />I AUNDRY'TRAN <br />UNIT ITT AIIRS-HIU M <br />CLOTE sSS'ASHIR <br />EVAPORATIVE COOLERS <br />WATER III All R <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION TAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I LOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BRIAK[RS <br />STOVE <br />ROOF DRAINS-RAINLI AD[ ITS <br />ME 1 AI I IRI PLA(:I A C1IIMNI Y <br />SINK ISER%'KA-RAR.ITT I <br />= 4. / AJL--S <br />00 <br />SUBTOTAL <br />SUBTOTAL B <br />PERMIT <br />S <br />PERMIT B <br />D <br />TOTAL FEE <br />S <br />TOTAL FFE F <br />OD <br />SIDE V.ARD St IHACK <br />STREIT SFIBACK <br />RE A4 YARD SE THMK <br />P I AN CRICK NUMD1 R <br />PI AN <br />[if <br />CHECK FFI <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FIE <br />71PI OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF FLOG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />ITT DROOMS <br />ITRL SPRINKLERS <br />REQUIRED <br />❑Y[S LINO <br />MECHANICAL <br />Q <br />APPROVALS <br />BY <br />DATF <br />OTHER <br />1 ENVIRONMENTAL CHECK LIS7 <br />PENALTY <br />UN( <br />5!C 3011a) <br />2 BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />4 FIRE PROIEC71ON SYSTEM <br />PERMIT VALIDATION <br />WHL" PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 CRADINGI[KCAVATIONACL[ARINGIGRUHIDNG <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATIM[NT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR IOR ISSUANCI BY <br />91.; 9 <br />