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T•L'i„(I'Eftl APPLICATION FOR <br />CONSTRUCTION <br />everett PERMIT <br />evereH <br />e <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION 11 BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />MAIL ADDRESS CITY ZIP <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE# <br />MECHANICAL CONTRACTOR MAIL ADDRESS "" _ <br />3-a"-�� �B•- 36ji l/ <br />WAIL <br />r <br />Fl ucur E1 Anmmr-I�N I IAI TFRATION .REPAIR <br />CITY <br /># <br />❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />ro <br />$ <br />DESCRIBE WORK 7 r <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PROPOSED USE Of BUILDING <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY ISNO\ BELO\V OR ATTACH FOUR-LOP1L51 <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOTB[ocK�DF <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 />7 / - OO 2--. Q 1 Z �--OOO <br />9 <br />SIGNATURE O/f/9ONTRACTOR OR AUTHORIZED AGENT DATE <br />S J (' ✓ <br />ION ADPRFSSAi <br />PLUMBING <br />MECHANICAL <br />TYPE OF EQUIPMENT FEE <br />NO.EGASFIREDAC <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />WATER CLOSET HOLIE E) <br />NITS-H l' FA <br />ION UNITS-H P. EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />.P. EA <br />.C. UNITS -TONNAGE [AK <br />SHOWER <br />T.0 M EAR5-BT.0 <br />ITCh1EN SINK 8 DISI'SYSTEMS-B <br />M <br />DISWASHER <br />UNIT HEATERS-B.T.U. M <br />LAUNDRY TNAI <br />EVAPORATIVE COOLERS <br />_ <br />CLOTHES WASHER <br />TI DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANG[ HOOD <br />AIR HANDLING UNIT- C I M <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLE AM RS <br />.METAL FIRIPLAC[ F CHIMNEY <br />SINK (SERVICE-IIAR, 11C ) <br />SUB TOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT S <br />FEE <br />S <br />TOTAL FEE <br />S <br />TOTAL <br />SIDE YARD SETBACK <br />PRFFT SETIIACK <br />RIAR 1'nRll SETBACK <br />PLAN CHECK NUMBER <br />PLAN CH <br />ECK FEE <br />RECEIPT NO. <br />III <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES CINO <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 SPRINKLERSREQUIR <br />MECHANICAL <br />MYTS FIND <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.R.C. <br />SEC. 3031a) <br />2, BUILDING PLANS <br />TOTAL <br />3. FIRE HYDRANT <br />4WHEPERM <br />FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />PROPERLYAT VALIDATED ON iH15 SPACE) THIS IS YOUR PERMIT <br />S GRADINGIIXCAVAI ION A CL I ARINGIGRUBIIING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC lit' <br />PLANS CHECKED By <br />APPR, FOR ISSUANCE BY <br />-! 1 79 <br />i <br />