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• , <br />G�- <br />1 <br />fMEwrynrn �-PPLICATIOIV FOI�- �����„ <br />"^'°` �ONSTRUCTION <br />everett PERMIT e <br />DEPT. Of COMMUWITY DEVELOFMENT SERV�CES <br />CITY HALL i59-B7�5 <br />EVERETT, WA9B201 ��OMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUIWSINC PERMIT NO. <br />UWNFq„ �/ �� � M�II ADOXFSS CIIV / 21P VMJNE <br />'��G 7i, � �..tr-�. °�9 ? �.1% ' ����� I�?�3 �s�s' � �� <br />�r�n[aoitvrsi H�a MAILe0D11t55 urr zir vwnwr <br />G[N[RAl CONiR.1CiOR M�R e�DRE55 CIiY ZIP PHONE ll[ErvSE I <br />hti(M�NIGI CONiR�:tOR MMl �07q65 CIIY !IP PHONE tICFNSE I <br />PIUA�PiNG[ONIY�CIOR MAllAO R[SS ❑LV ZIP PNONE IICENSEI <br />CUSS Of WORK ,j� � <br />❑NEW ❑ADDITION ❑ALTERATION ,171REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BU:I.DING RELOCATION <br />� � <br />o�scaieE <br />FNOPOSEO USF OI ppll0l�+L <br />0�' <br />j C�n _/ <br />ltWlUt)lXIv1iONOIVMOF[RIY�SMOWNfl[lON'OR�ii�CN{pURCOPIFS� I <br />'- - ' IEGAL DESCRIPTIOtJ <br />. 'i " . . � . �. <br />.. .. ���:) . . . �"tJ^� Tri f�� ql� � I.`1 <br />��` 9i i , ' - � . . „i.a rriA�T °�J� ^.i ' <br />, ' rr . , . � �. . , . � . . . <br />I <br />rwMeiNc <br />NO. TY►E OF FI1(TUIIE <br />BATHTU:1 <br />LAVATOPYIµ'�SH BASIN� <br />SHOWER <br />KITCHEN SINK 6 DISP <br />OISWASHER <br />LAUNDRY T0.AV <br />CLOTHES WASHfR <br />WATER HEAifR <br />URINAL <br />ORINKING FOUNTAIN <br />iIOOR JRAIN <br />VACUUM BRFAKf RS <br />ROOF DRAINS—RAINLF.\DENS <br />SINK �SFRVICE—BAR. FTC � <br />SU/iOTAI <br />►EIIMIi <br />iOTAIfEF <br />SIOE YARD SFiBACK STREFT SCTBA <br />USE ZONE LOT ARCA <br />TYPE OF �pNST. OCCUPANCY ( <br />SIZf Of BLOL. NO. OF 5T00.1 <br />FIRf ZONf 4 BASEMENT <br />AAl10VA13 <br />1 ENVIpONMENTAL CHECK LIST <br />2. BUILOING PUN$ <br />3 FIRE MYDRANT <br />/ fIRE PROTE[TION SYSTEM <br />5 GRADINGEI(GVriTION6QEARINGIGRUBAING <br />6 ORAINACE <br />L ENVIRONMfNTAL IMPACT SV.�EMENT <br />E. MEALTH DISTRICi <br />i HEREBY CERTIFY THAT 1 HAVE READ AND fXAMINED TFi;S AP- <br />PLICATIOIJ AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES COVERNINC?HIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />�R NOT. THE GRANTINC OF A PERMIT �OES NOT PRESUME TO <br />'E AUTNORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />' OTHER STATE OR LOCAL LAW RECULATING CONSTRUCTION <br />��iHE PERFORMANCE OF CONSTRUCTION. <br />\TURF OF CONTRACTJR OR AUTMORJZED ACENT �ATE <br />MECMANICAL <br />NO. <br />AIR COND. UNITS–HP. EA <br />REFRIGFRATICN UNITS–H.P. EA <br />POIlERS–MP FA <br />GA$ FlfED A.0 UNIT$–TONNACE EA <br />FOBCEU •IR SVSTEMS-8 T U. M EA <br />WALLMI.i[RS–B.TU M <br />UNITMEATERS-9TU. M <br />FVAPORATIVE COOlE0.5 <br />CLOTMES DRYFRS <br />RANGFHOOD <br />AIR HANDLING <br />METAL <br />f <br />{ <br />RUk YARD SFTBACN PUN CHE( <br />VACANT $IIE <br />❑YES ❑NO <br />+o ov owc�uNc uNirs <br />BUIIDING <br />NA% OCC LOAO <br />PIUMBING <br />` ��'^'� MCCMANI�AL <br />7YE5 ❑NO <br />�Y DAiE pTMFR <br />APPLICATIOY ACC BY PUN$ CHFCKE� BY � APPR FOR �SSUAN�E <br />PfNAITY <br />SU� TOlAI ! <br />_ iE�MIT y <br />101A1 iFE f <br />NUM9E3 PL.�N CIiFCK FEE <br />FEE RECEIPTNO. <br />fEFS VALUAiION ►EE <br />— S � � QJ <br />U.B C <br />•EC.7071a1 <br />TOTAL <br />3.,2 0 p <br />�EIIMIi VALIDATION <br />WHFN PROPfRIV VAl1�ATED UN THIS SPACE� THIS IS YOUR PERM17 <br />