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PPFICATION F1 <br />CQNSTRUCTIO <br />everett PERMIT <br />DEPI OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-9745 <br />EVERETl, WA 90201 COMBINATION <br />R <br />MAIL <br />❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />CITY III` PHONE <br />everett <br />a <br />37-s9(D <br />/3t40 5kuJ2 r%)2 Ajp . e ej4 1 e `1Y13 <br />GENERAL CONTRACTOR' MAIL ADDRESS CITY ZIP PHON[ LICENSE IT <br />S35-c:0a-7cR <br />MECHANICAL CONTRACTOR MAIL ADDRESS CIIIZIP PHONE LICENSE IT <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY IIP PHONE LICENSE I <br />CLASS OF WORK \ <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE Y/1 SI CN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WOKK I� <br />Td <br />DESCRIBE WORK / ' / (� <br />76 <br />PROPOSED USE 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 HCREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL T4E PROVISIONS OF <br />ANY FATHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION, <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE /� /-7E <br />x S� .l eLt a C <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT OLOCK_OF <br />IOB <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-11 P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS—B P. LA <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS-11 TU M LA <br />DISWASHER <br />15'ALI. I ILATERS—BTU &I <br />LAUNDKY TRAY <br />UNIT HEATERS—B I U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />-LOTHFS 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 —RAINLEADE RS <br />.METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR, ETC) <br />SUB TOTAL <br />SUB TOTAL 3 <br />PERMIT <br />3 <br />PERMIT 3 <br />TOTAL FEE <br />S <br />TOTAL FEE 3 <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SELL ACK <br />PLAN CHECK NUMBER <br />PLAN <br />HE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONCE <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST, <br />OCCUPA'.CY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BI.OROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />MIS ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />_ <br />OIHIR <br />1. ENVIRONMENTAL CLICK LIST <br />PI NALT 1" <br />Oil( <br />SIT ]01L0 <br />2- BUILDING PLANS <br />B. FIRE HYDRANT <br />TOTAL <br />67 <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE)THIS IS YOUR PERMIT <br />5 GRADINCIEWAVATION& CIA ARINGIGRUBBING <br />b DRAINMA <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />AI PLICATION ACC. BY <br />PUN C14CKED BY <br />APPR 1(4 ISSUANCE Y <br />i 1's779 <br />9.) -q <br />