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APPLICATION FnR r,-,,; <br />CITYOF romO CONSTRUCTIO,4 <br />CITY O <br />everett PERMIT iir <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HAIL 25M745 <br />EVERETT• WA98201 GICOWANATION ❑ BUlLJING <br />OWNER MAIL ADDRF". <br />C Pc..,f .b- 41 jDo -/11lr~67 <br />uMRICT OR DESIGNER MA:: AODRCSS <br />ADDRESS <br />❑MECHANICAL ❑PLUMBING <br />PERMIT NO. <br />- <br />_ CITY <br />ZIP <br />PHONE <br />C I'. <br />ZIP <br />PHONE <br />o L%RTIA <br />anc 9/`:c/9 <br />D <br />^ <br />COY <br />Zlp <br />PHI;NI <br />.j!✓ -Z%0,2C,-1nsl <br />CiT. <br />ZIP <br />PPOM <br />UCENS` I IF <br />T;NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION LJFENCE LJSIGN UGARAGE UBUILDINE; RELU(.AnVs <br />VAIUAIION OF WORK OV <br />�Z72 • - <br />DESCRIBE WORK <br />PROPOSED USE 01 BUHOINC <br />!'li aTe- - <br />LECAL DISCRIPT10N 0' PROPERTY 15HOWN BEL/OW� OB ATTACH FOIIP. COP"'; <br />LOT ___ BLOCK _OF <br />KaNGE SG W/1'1� S.voheml.3�% <br />7 <br />PLUMBING <br />No. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />WATER HEATER <br />FLOOR OKAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />FEE <br />PERMIT B <br />TOTAL FEE B <br />SIDE YARD S TBACK <br />STREET SETfpACK <br />REAR YARDS Sj� BA <br />hI <br />N/A <br />/4 <br />USE ZONE <br />LOT AREA <br />°G+ <br />VACANT SITE <br />- 2 <br />ILg740 Z.7s <br />Evrs ❑No <br />TYPE OF CONST <br />OCCUPANCY ROUP <br />NO OF DWELLING <br />$�. N <br />)2- <br />120 <br />SIZE OF BLOC <br />NO OF STORIES <br />MAX O�4o <br />40 I0,41(o'AIC '1 <br />2 <br />� <br />FIRE ZONE I BASEMENT I BEDROOMS <br />APPROVAL <br />1 ENVIRONMENTAL CHECK LIST <br />2 BUILDING PLANS <br />1 FIRE HYDRANT <br />R 9RE PROTECTION SYSTEM <br />S GRADINGIE KCAVAT ION& CLEARINGIGRUBRING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />+Lj M <br />BY I DATE <br />APPR FOR ISSUANCE BY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS Aa <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRLC'i <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 1 MITE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEF' IN <br />OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME () <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCI,IITJ <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATU/E�,=CONtR OR AUTMORI�OACENT DATE <br />YT��L�v[e�, <br />MECHANICAL <br />TYPE OF EQUIPMENT RILL . <br />AIR COND UNITS-H P EA Y - <br />REFRIGERATIONUNITS-HP EA _ <br />BOILERS -HP EA <br />GAS FIRED AC UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS -BTU MEA - <br />WALLHEATERS-BTU M <br />UNIT HFr TERS-BTU M <br />EVAPORATIVE COOLERS <br />'T 1 <br />VI NTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNIT <br />STOVE <br />METAL FIREPLACE & <br />PLAN (HICK NUMBER <br />FEES <br />M <br />Y 1 1-__ <br />SUB TOTAL E S'Z.='•' I'�= <br />►[RMIi <br />TOTAL FEE <br />PLAN CHECK FEE �7 <br />TF REC IP _gO I <br />�}�P�, <br />BUILDING <br />S/ Ira 272.. <br />3.1 408 <br />w!� <br />PLUMBIN: <br />MECHANICAL <br />(2 Fo <br />OTHER <br />PENALTY <br />UBC <br />SEC 203(R) <br />_ <br />TOTAL <br />,J l �Z <br />I �'• <br />P[AMIT VALIDATION <br />W 'I IN PROPERLY VAT IDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />9.1-79 <br />