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.�' <br /> , - <br /> , � <br /> P-PPLICATION FOP <br /> �°""'� �,ONSTRUCTION e <br /> everett PERMIT <br /> DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br /> CITY HALL 259�8745 <br /> EVERETT,WA9B201 ��OMBINATION ❑ BUILDING ❑MECHANICAL �LUMB�!:c PERMIT NO. <br /> : �r�WNER M�II�DOME55 CITY ZIP PHONE <br /> �.i J�a�c� iso� s r�/s'd ,Fv'���r�-9�,�3 �s� -y�s/ <br /> �NCHI FCTOR ESIGNFR MAILAOUNE55 [ITY ZIP PMONE <br /> GENFR�I CONiR�CtON �.nMl ADDRE55 CITY 21P PHONE UCENSE/ <br /> MECH�NIUICONTN�CiOR MAILADDR�55 ❑TY LIV PHONE IICENSF� <br /> PWMPIHLCON1pACTOk M�II�OORE55 UTY ZIP PNOrvF ll[ENSF• <br /> . <br /> ClA55Of WORK <br /> ❑NEW ❑ADDITION �ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br /> V�W�110NOf WORIt <br /> f <br /> y(1E5[RI O <br /> � O • <br /> �FROPOSF USF Of BUIIDI j I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS nP- <br /> l <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> IEGAI O6CRIPLION Oi VpOPFRtt�SMOWN FcIOW ON eiT�[H fOUR COPIESI PROVISIONS OF LAWS AND ORDINANCES COVERNING THIS TYPE <br /> OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> lOi�BIOCK�Of 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 /> $IGNATURE OF CONTRACTON OR AUTHORIZED A NT� DATE <br /> Xioa��➢a��� cS�G�'/5� �h X l � � � <br /> /,7 Or <br /> ', PLUMBING MECHANIGL <br /> ' NO. TY�E OF FI%TURE FEE NO. TY►E OF EQUI�MENT FEE <br /> � WATER CLOSET(TOLIET) AIR CONO.UNITS-M.P.EA <br /> �� BATHTUB REiRIGERATION UNIiS-MP EA <br /> ' UVATORY�WASM BASIN� BOILERS-MP. fA <br /> � $HOWER WS FBED A C.UNITS-TONNAGE EA <br /> KITCMEN SINK 8 OISP. FORCFD AIR SYSTEMS-B.T.U. M EA <br /> �. DISWASMER WALL h EATERS-O.TL. M <br /> . UUNDRY TRAV UNIT Hk�TERS-BSL. M <br /> , CLOTHES WASHER EVAPORATIVE COOLERS <br /> �, WATEN HEATER CLOTHES�RYFRS <br /> I URINAL VENTIUTION FAN <br /> � DRINKINC FOUNTAIN RANGE HOOD <br /> FLOOR DR�IN A10.MANDLING UNIT— CFM. <br /> , VACUUM BREAKER$ STOVf <br /> � ROOF�0.AIN5-0.AINLEADERS METAI FIBEPLACE 8 CHIMNEY <br /> � SINKIStdVICk—BAR,ETC! � tl[.TS� <br /> SU�70TAL SU�iOTAI f <br /> ►ElMli 3 �f�MIT � <br /> TOTAL iFE f TOTAI FFE � �O <br /> $IDE YARD SETBACK STRfET SETPACK REA0.YARD SETBACN PLAN CHECK NUMOER PLAN CHECK FEf <br /> FEE RECEIPT NO. <br /> USI Z01 LOT AREA VACANT SITf <br /> ❑YES ❑NO iFES � VALUAiION fEF <br /> 7YPE V� f OCCUPANCY G0.0UP NO.OF DWEILING UNITS � <br /> BUILDING f <br /> L�E OF BLDG. NO.OF STORIES MAk.OCC.LOAO <br /> PLUMBING <br /> fIRE ZONf BASEMENT BkDROOMS FIRE SPRINKLERS <br /> REQUIREU MFCHANIGL <br /> � � - ❑YF$ L1N0 <br /> - M►ROVAl3 �Y DATF OTHER <br /> 1. ENVIRONMENUICMECKLIST U.BC. <br /> PENALTY SEC.30Na1 • <br /> 2. BUILDING PLAN$ <br /> l FINF MYDRANT TOTAL <br /> ♦. FIRE PROTECTION SYSTEM HIIMIT VALIDATICV <br /> WHEN PROPERLY 4ALIDATED�IN THIS SPACE)THIS IS YOUR PERMIT <br /> . 5 GRADINGIE%CAVATIONBCLE�RINGGRUB9ING <br /> � 6. ORAINAGE <br /> 7. ENVIRONMENTALIMPACTSTA7EMENT <br /> E. MEALTM DISTRICT <br /> ' AVPLIC�710N ACC.BY PLANS CHECKED BY APPR.fOR ISSUANCF BY <br /> 9�1-79 <br />