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APPLICATION FOR <br />FA,EF.,P,,,R <br />DI'~`F <br />CONSTRUCTION <br />evereft <br />PERMIT <br />e <br />DEPT OF COMMUNITY DEVELOPMENT <br />SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA 98201 COMBINATION <br />FerBUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER <br />PHONE <br />MAIL ,UURI SS i fi �Y� /l �Kl' <br />.T/ <br />ARCHIlICTO 0F51CNfR <br />FAR ADDRESS CITY ZIP PHONE <br />— x/ ecRIESS <br />(%-/ dfc° /fl3GT <br />GENERAL; <br />ENERAL ryy /�10„r <br />�IL AD7+/ CH���'�/� ZIP LICENSE <br />NI�CHA))CAIjO♦TRACTOR <br />MAIL ADDRESS CITY / LIP PHONE LICENSE <br />PI Um III NL C O N L RAC i OR <br />MAIL ADDRESS / CIIY ZIP PHONE F - LICENSE IF <br />CLASS Of WORK <br />❑NEW ❑ADDITION ❑ALTERATION <br />I��1��-. <br />❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN WE5ARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />T </ <br />DESCRIBE WORK <br />eln <br />PROPOSED USE Of BUILDING <br />P <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 />LEGAL DESCRIPTION OF PROPIRTY (SH NUI )H OR IF -H rou coPl <br />-�-7,/ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />LOT/7 /Y BLOCK i i r of <br />/`� <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 CONTR TOR OR AUTHORIZED AGENT DATE <br />FOR ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE <br />FEL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET IIOIIF TI <br />AIR COND UNITS- IF P EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED A UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK R DISP <br />FORCED AIR SYSTEMS-B.T U M EA <br />DISWASHER <br />WALE HEA7ERS-BTU M <br />LAUNDRY TRAY <br />UNIT HEATLRS-BTU M <br />CL 07 lit WASHER <br />IVAPORADVI COOLERS <br />N'ATLR HEATER <br />CLOIMES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />MOOR DRAIN <br />AIR HANDLING UNIT- C FM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLE AD[ RS <br />METAL FIREPLACE d CHIMNEY <br />SINK (SERVICE -BAR. ETC) <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK . <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />/cx?z�)q <br />FE�G�j <br />RECEIPTNO. <br />�2 <br />USE ZONE <br />LOT AREA <br />VACANT SI <br />—, <br />❑YES E3fi0 <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />1\1 <br />M <br />BUILDING <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX OCC LOAD <br />I o J. }: <br />I <br />--' <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BIDROOMS <br />FIRE SPRINKLERS <br />REQUIRED— <br />MECHANICAL <br />`-' <br />-- <br />'- <br />C)YES MfNo <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHECK LIST <br />UBC <br />Pf NAI TY <br />SEC. 303(a) <br />2 BUILDING PLANS <br />3 TIRE HYDRANT <br />TOTAL <br />c <br />Z <br />J FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 15 YOUR PERMIT <br />S GRADING:IXLAVATIONRCLLARINWGRUBBING <br />DRAINAGE <br />LI,�TS I _ Tr <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />7 <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED <br />BY <br />APPR IOR ISSUANCE By <br />L • c, <br />G <br />i <br />9 1 79 <br />