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TM EE.EpnRn APPLICATION FOR,.. <br />cln of <br />%..ONSTRUCTION `�`P`" <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2598705 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />ORDI SIDNIR MAIL ADDR05 CITY ZIP PHONE <br />n l.n✓� <br />GENERAL CONTRACTOR L AIL ADDR[55 CITY ZIP PHONE LICENSE IT <br />MICHAN(CAL CONTR.CTOR A/%- MAIL ADDRESS CITY <br />MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />TLI.55 OF WORK��,,// <br />❑NEW MADDITION ❑AUTERATION ❑REPAIR ❑DEMOLI iION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />l'Al IION OF WORK ,y <br />coo, ° <br />DEscxIBE woRK <br />I�r�TcYL" %o 6 ?cc, 5 r�rtrc c� <br />PROPOSID LSE 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 AUTHORII Y TO VIOLATE OR CANCEL THE :PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />�!gNAA/RLPF.-C ACTED OR AUTHORIZED AGENT DATE <br />/ <br />X _ g 5 K <br />LEGAL DtSCRIPTI'JNOF PROPERTYISHOwN BILOW'OR ATTACH FOUR COPIES) <br />LOT _BIocKor f qC �t S <br />IOR ADDRESS <br />1q J r we- % <br />PLUMBING �GLA✓l l yG <br />/ <br />MECHANICAL G C_ Ir.0 J Y /C L <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLI ETI <br />AIR COND UNITS-H P EA <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />HOILERS-H P EA <br />SHOWER <br />OAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS-8 T U M EA <br />DISWASHER <br />WALL HEATERS -BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU M <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 UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR. ETC! <br />SUE TOTAL <br />SUN TOTAL E <br />PERMIT <br />E <br />PERMIT E <br />TOTAL FEE <br />E <br />TOTAL FEE E <br />_ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />$/ <br />�� <br />PLAN CHECK FEE <br />FEE •3 RECEIPT NO. <br />_6�cj <br />�• �� <br />USF ZONE <br />LOT AREA <br />VAUN�T jITE <br />[DYES SC['O <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />N <br />OCCUPANCY GROUP <br />' (` _ f <br />NO OF DTY'TEEING UNITS <br />/ <br />BUILDING <br />S <br />c / <br />SIZE OFF_ BLDG <br />64 x 1q /0 <br />NO OF STORIES <br />1 <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE SPRINKLERS <br />REQUI REQ <br />❑YFS PfNO <br />MECHANICAL <br />APPROVALS <br />EY <br />DATE <br />OTHER <br />! ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.B C. <br />SEC 308R) <br />2 BUILDING PLANS <br />TOTAL <br />r !{ <br />q <br />V <br />7 FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 CRADINGII XCAVAT ION& CLf AR INGICRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />' <br />5 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />n' l <br />APPR FOR ISSUANCE BY <br />91 79 <br />