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APPLICATION FOP eVe <br />TITLE Ewryr..n ,O N ST R U CT I O N <br />CITY OF <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING EiMECHANICAL ❑PLUMBING PERMIT NO. <br />OWNf0. MAIIAUDN(SS 01Q�Z.( cdVTYfL��OCVr arc �3.o3PIlONE ,7�5_3gi.Z <br />�G* L <br />ARCHITECT OR DESIGNER MAIL AODKI55 CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE# <br />MOi CwICAL CC10R <br />MAIL ADDRESS <br />CITY <br />LIP PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />CLASS OF WUKK <br />9r NEVV ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION [IF ENCE ❑SIGN ❑GARAGE El BUILDING RELOCATION <br />VALUATION OF WORK <br />4 <br />DE SCRIYI WORK <br />1 N ST'R"I Ms, G; 4 dh is My E <br />PROPOSED USE Or RUIIDIN6 <br />R>=51 D r=9f-r-- <br />LtCAI DESCRIPTION OI PROPERTI (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOI � B1OCX�OF <br />4SoAa95- Z T4k Ay Lam) <br />PLUMBING <br />NO. TYPE OF FIXTURE FEE <br />WATER CLOSET(TOLIFT) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHU.. 'R <br />KITCHEN SINK 8 DISP _ <br />DISWASHER <br />LAUNDRY TRAY <br />I HEREBY CERTIFY THAT 1 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 PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X -7•nA A LJali t�GRi d- <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />AIR CONE) UNITS —IT P. EA <br />Rf FRIGERATION UNITS —HP EA <br />BOILERS —HP EA <br />CAS FIRED A C UNITS —TONNAGE EA <br />FORCED AIR SYS-EMS— B I U MIA <br />WALL HEATERS—f TU M <br />UNIT HEATERS-1 TU M <br />HEATER -_ - <br />VENTILATION FAN <br />L <br />ING FOUNTAIN RANGE HOOD <br />_... _.I I AIR HANDLING UNIT— C F M <br />ROOF DRAINS—RAINIE ADf RS ME7At FIREPLACE 8 CHIMNEY R� <br />SINK ESERVICL—BAR, ETC I I LIMP <br />V <br />Sue <br />s <br />SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK , PLAN CHECK NUMBER FEE <br />USE ZONE LOT AREA VACANT SITE r FEES <br />OYES ONO <br />TYPE OF -HST OCCUPANCY GROUP NO OF DWELLING UNITS <br />BUILDING $ <br />51II Of BIDG NO. OF STORIES MAX OCC LOAD <br />PLUMBING <br />FIRE <br />APPROVALS <br />1. fNSIROI MENTAL CHECKLIST <br />2. BUILDING PLANS <br />J FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 GRADINGIEXCAVATIONBCLEARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />BY I PLANS CHECKED BY <br />I EQUIRED MECHANICAL <br />7YE5 ONO ,E' <br />BY DATE OTHER <br />FOR ISSUANCE <br />E <br />;HECK FEE <br />RECEIPT NO. <br />U.BC <br />.PENALTY SEC. BOXa) <br />TOTAL <br />FEE <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE)THIS IS YOUR PERMIT <br />9.1-79 <br />