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I r <br />1I <br />r <br />I L <br />IN EYBFBF»D .._APPLICATION FOR L:V� <br />CITY OF CONSTRUCTIO1. 0 <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />74 <br />CITY HALL 259-0 S <br />EVERETT, WA98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADORE ttdA7 AW <br />CIIT ZIP PHONE <br />,-;I9 c1—c amosE <br />LiVIT y5-9 --5 <br />ARCHITECT OR DESIGNER MAIL AVOK151 <br />CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENSER <br />42'gge / Co Zpyc 2raz7 <br />(ES—"' CN , LYti.E/ C rH 98036 2`7/ RR3_f _0FRA'N 2IE`7LJo <br />MICHANICAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENSE <br />PLOMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENSER <br />CLASS OF WORK <br />[:]NEW ❑ADDITION ❑ALTERATION ]REPAIR <br />�( <br />❑DEMOLITION ❑FENCE ,i^_ISIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUMIOF WORK <br />i? 0 �� <br />R <br />DESCRIBE WORK <br />P70POSIO LSE OF BUILOLc <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />r�L FRy2!a e-- /FL 8rt3�A17 <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL Ul SCNIP110N OF PROPERTY It110WN tlIION'OR ATTACH FOUR COPII51 <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />Lot <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />_BLOCK__Of <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 />lux ADORltt <br />X <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET JOLIET) <br />AIR CONO UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS—H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS —BTU M EA <br />OISWASHER <br />WALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS—B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COO[ERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR pRA1N <br />AIR HANDLING UNIT— C. F M <br />VACUUM BREAKERS <br />51OVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE F. CHIMNEY <br />SINK (SERVICE —BAR, ETC) <br />SUB TOTAL <br />SUBTOTAL <br />S <br />PERMIT <br />E <br />PERMIT <br />B <br />TOTAL FEE <br />F <br />TOTAL FEE <br />S <br />SIDE ARD SE TRACK <br />Y <br />USE ZONE <br />TYPE Of CONST <br />SIZE Of 11LOG <br />SIR[ SETBACK <br />REAR LARD SI TBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FFF <br />CHECK FEE <br />RECEIPT NO. <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VAIUATION <br />FEE <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />NO OF STORIES <br />•IA% OCC TOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />)BEDROOMS <br />INKLERS <br />FIRE REQUIRED <br />OYES ONO <br />MECHANICAL <br />A►PROVAL$ <br />1 ENVIRONMENWL CHECK LIST <br />2 BUILDING PLANS <br />BY <br />DATE <br />OTHER <br />PENALTY <br />UBC <br />SEC TOAa) <br />TOTAL <br />47 <br />S FIRE HYDRANT <br />L A FIRE PROTECTION SYSTEM <br />S GRADINGE%1'AVATION&CLEARINCICRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY PI ANS CHECKED BY <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />APPR FOR ISSUANCE BY, <br />"1 <br />I <br />L <br />9.1.79 <br />J <br />