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IM EFI <br />BIR C N <br />oe <br />CITY OF LJNSTRUTIO <br />everett PERMIT DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 ,_,., <br />EVERETT,W'A9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL M*LUMBING PERMIT NO. <br />P6;awbLR Q l /g"+All ADDR(S! CITY 11r PHONE <br />wB U-4t GUll— GoohA��'Gh.Ls J Po )3D 7� / 9'Vy ✓cvc. 9'Plc)G <br />ARC H II I C T OR DI S I CN I MAIL ADDRESS CITY ZIP PHONF <br />vE_I L/FAPC.&LLU <br />USt ORK <br />E\V ❑ADDITION ❑ALTERATION ❑REPAIR DEMOLITION ❑FENCE ❑SIGN ❑GARAGE []BUILDING RELOCATION <br />%ALUA IFUN UP wuxa <br />S <br />DESCRIBE WORK 1 <br />Pgaoslousl 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 PERFOR ANCE OF CO STRUCTION. <br />SIGNATURE OF C TRACTOR OR OR IZE4 AGE T DATE <br />LIr.AI DESCRIPTION OF PROPERTY ISHOSTN B(LOSS OR ATTACH FOUR COPIES) <br />LOT _aLOCK_or <br />ION ADDRESS <br />_q LIT <br />PLUMBING <br />MEC ANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIFT) <br />-_-- <br />AIR COND UNITS-H P EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS FIRED AC UN175-TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR 5YSTEMS-B T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-B I U AS <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />fLOOR DRAIN <br />AIR HANDLING UN'.T CI M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLE ADL RS <br />METAL FIREPLACE &CHIMNEr <br />SINK (SERVICE -BAR, ETC) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FIT <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREIT SETBACK <br />REAR YARD SE TRACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEF <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT ARIA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />i <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOA55 <br />FIRE SPRINKLERS <br />REQUIRED <br />')IS ETNO <br />All( IIANICAI <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC 303W <br />2 BUILDING PLANS <br />1 FIRF HYDRANT <br />TOTAL <br />4 FIRE PR07ECIION SYSTEM <br />PERMIT VALIDATION <br />SEEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT <br />% c/J <br />✓,FJ �Jv <br />A 5 GRADING4 XCAVAIION CIE ARINCfGRUBBINGMISSUAICI <br />b DRAINAGE <br />1 ENVIRONMENTAL IMPACT STATEMENT <br />A HEALTH DISTRICT <br />APPLICATION ACC fly <br />PLANS CHECKED Ph <br />am <br />