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APDLICATION FORLINE Re <br />CITY OF °"" CITY WNSTRUCTION 0 <br />OF <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-0745 <br />EVERETT. WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />CITY zip PHONE (� <br />OWMf R MAIL AODRI55 A Ay - _14 - -2 '' ? — -%3 �% '?. i - <br />L- l <br />CITY ZIP IHONI LICENSE. <br />MAILADORI SS <br />mow' J.G C, y' <br />ZIP P I llc[NSL <br />IF <br />Ss <br />Ct ASS OF %ORK <br />nwcw ❑ADDITION []ALTERATIONyQ[PAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE BUILDING RELOCATION <br />SALUATION OF WORK j <br />IF Zi rr. <br />�ROPOSID USE OI BUILDING Y <br />LEGAL DI SCRIP110N OT PROPERIY (SHOWNBIBIItOW OR ATTACH FOUR CQPIES) <br />c <br />101�/i-�/� FLORA OF <br />,OR ADDRISS <br />PLUMBING <br />TYPE OF FIXTURE <br />SHOWER <br />KITCHEN SINK A DISP <br />DISWASHI R <br />I AUNDRY TRAY <br />WATER HE <br />URINAL <br />DRINKING <br />I I ODIC DR <br />VACUUM <br />KIN <br />RS <br />AINIFAVIRS <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT 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 ANY OTHER RIVIOLATETY TO <br />ATE OR LREGULATING OCAL LAW CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNNAAIURE Of CONIRACTOR OR AUTHORIZED AGENT DATE <br />TYPE OF EQUI►AAlnl <br />AIR COND UN'I1S-HP fA <br />Rff RIGFRK110N UNITS -HP to <br />P IA <br />POIII RA -II <br />GASfIREUAC UNITS-IONNAGt EA <br />FORCED AIR SYSTLMS-RTU M <br />WAtLHIAIIRS-BIU M <br />UNIT NI AIt RS-RIU M <br />IVAPORA71VI COOLERS <br />CLOIHtS DRYERS <br />VI NTILAI ION tAN <br />RANGE HOOD _ <br />AIR MANDIING UNIT- C t M <br />STOVE <br />MFIAI FIRIPLACE &CHIMNEY <br />FEE <br />SUE TOTAL <br />SUS TOTAL <br />PERMIT S <br />PERMIT <br />IS <br />TOTALFEE S <br />TOTAL FEE <br />S <br />PLAN CHECK FEE <br />STREET SLTBACK <br />RLAR YARD StiBACK <br />PUN CII[CK NUMfl10. <br />fil RECEIPT NO. <br />51DI YAPD 9TRACK <br />USE 20Nk LOT AREA <br />VACANT 5111 <br />FEES <br />VALUATION IF <br />GYLS GNO <br />l YP[ Of CONST OCCUPANCY GROUP <br />NO Of DWELLING UNIT$ <br />BuuolNc <br />' 3 OOo <br />SIZE OF flLDG NO Of STORIES <br />MAR OCC LOAD <br />PIUMBING <br />FIRE ZONE BASEMENT HE DROOAIS <br />FIRE <br />SRfIDNKLIREQUIR' <br />MECHANICAL <br />7,YFS (7NO <br />APPROVALS <br />SY DP.Tt <br />OTHER <br />UBC <br />I INVIRONMt N1AL CHECK LIST <br />PINNTY <br />51C TOHa) <br />2 BUILDING PLANS <br />TOTAL <br />I TIRE HYDRANT <br />PERMIT VALIDATION <br />TIN iN155PACEI THIS IS YOUR PERMIT <br />A FIRE PROlF C110N SYSTEM <br />WHEN P0.UP[RLY VALIDATED <br />5 GRADIN(7EXCAVATIONACLIARINGIGRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT SIAIEMENT <br />S HEALTH DISTRICT <br />APPI ICAI ION ACC BY PUNS CHECKED BY <br />APPR FOR ISSUANCE BY <br />91 79 <br />