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) <br />LAB Ewrown <br />CITY OF <br />APO"CATION FOR <br />everett `ONP RMITTION <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT. WA 98201 ❑COMBINATION <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />VW _ MAIL AUIIMi I] un I., rn— <br />1 O.C+ar,� JZ�11ni �!� %CC>S�IS'I- F1)vfeti <br />OR DISIGNFR <br />MAIL <br />rmum[ <br />GENERALL CONTRACTOR MAIL ADDRESS CITY ZIV PHONE LICENSE E <br />Zc�t•n�E tK•n1LSi aoc- SU�V 01),CST �P1Eli �)-L-tf li,�ao3 �75�1(cSYFi o50?3 71/2COF�L9/�4/i�`r <br />AIICNAMCAI NTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />CLASS OF WORK ,,--..�� - <br />❑NEW ❑ADDITION ❑ALTERATION E REPAIR ❑DEMOLITION ❑FENCE ❑SIGN [:]CAR;,,:' ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />S , SUo-Oo <br />DLSCRIBF WORK -Dr,rimpi+- �E <br />1 )):cl �.3SG, cE:P� - :7�C'/�iU.r S�AIiFS <br />PROP06CD usF of BmlolNo <br />RPS ; C�Q(1 12k I <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 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 LUNIRACTOR OR AUTHG.-'ZED AGENT DATE <br />77 '1 J�Q <br />LEGAL DFSCRIPTIONOF PROPEPTY(SHOWN BELOW OR ATTACH IOUR COPIES) <br />LOT -FLOCK -OF <br />_ <br />- <br />LOP App0.F55 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOLIET) <br />AIR COND UNITS—H P 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 ,`•INK A OISE <br />FORCED AIR SYSTEMS—B T U M EA <br />DISWASHER <br />WALL HEATERS—B T U 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 />SUB TOTAL <br />SUB TOTAL f <br />PERMIT <br />S <br />PERMIT _ IF <br />TCTAL FEE <br />S <br />TOTAL <br />FEE f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHE K NUMBER <br />� XV tT E� <br />PLAN <br />FIE <br />CHECK FEE <br />RECEIPTNO <br />ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S�SOO i <br />OL <br />O <br />5� <br />SIZE OF BLUE;NO <br />OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />HL UROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />❑YES PNO <br />MECHANICAL <br />_ <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />URIC <br />SEC )01(a) <br />6 <br />BUILDING FLANS <br />TOTAL <br />p. <br />3 O <br />) FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 GRACINGI1 XCAVAT ION& CC I AR INGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />AVER 'OR ISSUANCE BY <br />