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APPUCATION FOR <br />CITY OF everett <br />T Evergreen• CC A S T R U C T I O N e <br />C <br />evereit PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICA ❑PLUMBING PERMIT NO. <br />MAIL ADDRESS CI: ZIP PI10NE <br />OWNER _ . , <br />ARC110R OF$IGR MAIL ADDRESS CITY ZIP 1'HUN[ <br />11EC1NE <br />GIMBAL CONiRACTOR MAIL AMAISS CITY V ZIP �- - - PHONE LICENSE w • • ' LICENSE P <br />b� V � . an ZIP PN wt • • <br />All GIIAM1ILAI COh IRA(' ION MAIL AUUIHSS <br />aa3-4/-Eli-6xF-EB <br />PLUMBING CONTRACTOR MAIL ADDRESS OlY ZIP PHONE LICENSE E <br />CLASS OF WORK ❑t <br />yy <br />❑NEW ❑ADDITION RALTERATION lit 'AIR ❑DEMOLITION ❑FENCE ❑SIGN [:]GARAGE❑BUILDING RELOCATION <br />vnlLAnoN OF WoxK <br />1 'I t' <br />oia v <br />DESCRIBE 1YONA <br />ITOPF "t, <br />I HEREBY ["RTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE 01 BUILDING <br />PLICATION AND KNOW THE SAME TO BE TRUE .AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION Of PROPERTY (SHOWY. BELOW OR ATTACHfOU0. <br />COPR SI <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />N a9l - �58-031-O <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT _BLI"_OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />n r ti) Cl 3 �r ] <br />- <br />ANY OTHER. STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />yV <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />�P1 o f O r 'E veave H <br />r C <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LOB Auuxtss <br />X <br />MiCHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND UN115—HP EA <br />WATER CLOSET 170LIETI <br />REFRIGERATION UNITS—H. P. EA <br />RATHIUB <br />BOILERS -HP EA <br />LAVATORY IWASH BASIN) <br />GAS FIRED AC UNITS -TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />KITCHEN SINK EL DISP <br />� <br />WALL PEATERS-BTU M <br />_ <br />DISWASMER <br />IL. <br />UNI7 HEATERS-BT U AT <br />LAUNDRY TRAY <br />'1 <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CL07I1F5 DRYERS <br />WATER HEATER <br />`VENTILATION FAN <br />URINAL <br />$■ <br />{: RANGE HOOD <br />DRINKING FOUNTAIN <br />40 <br />AIR HANDLING UNIT- C F M <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />ammo <br />S7oVl <br />HOOF DRAINS-RAINLEADERS <br />? <br />METAL FIREPLACE R CHIMNEY <br />SINK (SERVICE -BAR, ETC 1 <br />T <br />SUB TOTALPERM11 <br />SUB TOTAL <br />SPERTOTAL <br />TOTAL iFE S <br />FEE <br />S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN Cli[CK NUMBER <br />PLAN <br />PLAN <br />CHECK FEE <br />RECEIPT NO, <br />USE ZONE <br />LOT AR !. <br />VACANT S11E <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />TYPE OF CON5T <br />OCCUPANCY GROUP <br />NO OF DWELLING UNIIS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX. OCC LOAD <br />I•LUMBING <br />FIRE ZONE <br />BASEMENT <br />III DRDUMS <br />ES <br />REQUIRED FIRE SPRINKLERS <br />MECHANICAL <br />FIYES ❑NO <br />APPROVAL; <br />BY <br />DATE <br />07HER <br />PENALTY <br />U BC <br />SEC. JDJ(aI <br />1 ENVIRONMENTAL CHECK LIST <br />TOTAL <br />2. BUILDING PLANS <br />J FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACE( THIS IS YOUR PERMIT <br />5 GRADINGIEKCAVATION R CUARIIJGIC RUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />4APPROR <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />ISSUANCE B` <br />9-1-79 <br />