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APPLICATION FORfive <br />ert,eET <br />CE"OF BF»O ..ONSTRUCTION e <br />cm <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 25+8745 <br />❑ <br />EVERETT. WA98201 ❑COMBINATION BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />pWrylq / MAIL ADDNf 55 CITY 21P PHONE <br />o ,,% MT C�%�fl 3yGg G�1 lr {mil, TY ere %5-zoi) <br />ARCHITECT OR DESICNIR MAIL ADDRESS CITY ZIP PHONE <br />CENTRAL CONTRACTOR MAIL ADDRESS CITY 21P PHONE LICENSE R <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />PLUMBING CONTRACTOR NAIL ADDRESS CITY ZIP PHONE LICENSER <br />CLASS Of WORK <br />❑NEW ❑ADDITION ]ALTERATION ❑REPAIR ❑DEMOLITION FENCE. ❑51CN ❑GARAGE ❑BUILDING RELOCATION <br />Y'AIUATION Or WORK <br />5 3 U2; O v <br />DESCRIBE WORK <br />. , L I L _ E - — `- <br />PROPOSED USE Or RUILDINC <br />LEI. L O S RIP110N OF PROPIRTY (SHOWN MICA OR ATTACH LOUR COPIES) <br />Ln�. Nr E rr. <br />LOT )TINS FLOCK— or �`tt O� �ver� IV l\• <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 CONTRACTOR OR AUTHORIZED AGENT DATE <br />S �i <br />TOR ADDRESS <br />'iI11 o7'1 5T_ , If- e%_�_ <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 Ed <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE FA <br />KITCHEN SINK 6 DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHFR <br />WAIL HEATERS-B T U. M <br />LAUNDRY TRAY <br />UNIT HFATERS-B T U 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-RAINUADFRS <br />METAL FIREPLACF A CHIMNEY <br />SINK (SERVICE -BAR. E TC 1 <br />SUBTOTAL <br />SUP TOTAL IF <br />PERMIT <br />f <br />PERMIT f <br />TOTALFEE <br />f <br />TOTAL <br />FEE 1 f <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY 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 />BEDROOMS <br />FIRE SPRINKLERS <br />FINKLERSREQUIR <br />DYES DNO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UBC <br />SEC 70Xa) <br />2 BUILDING PLANS <br />TOTAL <br />T FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 GRAOINGII XCAVATION 6 CLLARINGIGRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS 15 YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />