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tA/ Ew(PrMM APPLICATION FOR 6Vef�„ <br />Cm OF ...CONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNtA MAIL ADDRESS (� (rtv -/.I_ ZIP PHONE <br />q g <br />ARCHITECT OR UtSIGN1R MAIL ADDR65 (III ZIP PHONE <br />C INIRAI CONTRA( FOR / II'' MAIL A1793tSS / Cily 71P PHONt TICE NSt1 <br />'F(.l..I F. a7t J 3 ADDRESS /tAw.. /a �-w ll .//(Q K• (II, ZIP PHOni HC(NS(. <br />MIT MANIC At (Oh1RAC 10R <br />PIUM0INC.CONiRAC1011 MAIL ADDRESS (IT, Tip PHONE IICtNltI <br />❑NEW []ADDITION ❑ALTERATION ❑REPAIR KUDEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />YALUAIIONOF WORK <br />IF <br />DIS(RIRI WORK <br />PROPOSED USI °I AU t DING <br />V <br />1 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 TH15 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 />L I Gel 01SCRI PT ION 01 PROP[ R IY(SHOW N BE OW OR AI TAC II TOUR COPII S) <br />tolls .76 atm% 1 ��� e cr..e Ti' _b , <br />— ��- °i <br />�1 <br />�,• 14 e co d Ir,,O o (....r J <br />1 / <br />FOB AOD SS <br />EV. c 58, <br />PLUMBING <br />MECHANI AL <br />NO. <br />TYPE OF IIXTURF <br />EEL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIETI <br />AIR COND UNITS-11 P 1 <br />BATHTUB <br />REFRIGERATION UNITS - III' I+ <br />LAVATORY (WASH BASIN) <br />BOILERS -LA P EA <br />5HOWIR <br />GAS FIRED AC UNITS-TORNACI U <br />KITCHIA' SINK A DISP <br />IORCED AIR SYSTEMS -BTU MIA <br />DI115"ASHtR <br />WALLHIATERS-BTU M <br />LAUNDRY TRAY <br />UNIT HCATERS-B T U M <br />CLOTHES W ASH) R <br />EVAPORATIVE COOLERS <br />W ATI R HEAT[ R <br />CLOTHES ORYI RS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />ILOOR DRAIN <br />AIR HANDLING UNIT- CFM <br />VACUUM BREAKERS <br />SIOVE <br />ROOF DRAINS -RAINLE ADE RS <br />METAI FIRIPLACI A CHIMNEY <br />_ <br />SINK (SERVICE -BAR, ETC I <br />SUR TOUT <br />SUR TOTAL IF <br />PLRMIT <br />f <br />PERMIT f <br />TOTAL FTI <br />S <br />IOUt ITT f <br />SIDI YARD SETBACK <br />STREET SETBACK <br />REAR YARD SITBACK <br />PLAN CHECK NUMBER <br />PLAN <br />Fit <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />III <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BE DROO.+tS <br />FIRE SPRINKLERS <br />REQUIRED <br />OILS ONO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHICK LIST <br />PENALTY <br />URIC <br />SEC TORq <br />2 BDII DING PLANS <br />TOTAL <br />I 1IRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />1 GRADINGII XCAVAIION& CLTARINGIGRUBBING <br />— <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />R HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />91 79 <br />L <br />