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the Ewfgwn APPLICATION FOR <br />CITY OF CONSTRUCTION <br />everett PERMIT e <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA98201 ❑COMBINATION ❑ BVILDING ❑MECHANICAL ❑PLUMBING . PERMIT NO. <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />LLlah } Viy,T -ID 06-)" a . -z ei1av s"3-YSJi <br />ARCHITECT OR DESIGNER MAIL ADDRESS F'ITY no e....... <br />MAIL <br /><R <br />PHONE LICENSE If <br />PLUMBING CONTRACTOR MAR ADDRESS CITY 71P PHOM LICENSE <br />CLASS OF WORK II��--1( <br />❑NEW []ADDITION ❑.ALTERATION ❑REPAIR [:]DEMOLITION rUFENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION DI WORK <br />\ ' -2? <br />ESCFti WORN <br />j <br />_PRO PDSEDUSF OF BUILDING <br />el..n ✓, <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 />X it ', , �C •., /%.�.....L- bld C/, .i,/yd, <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT -2 BLOCK _OF t S' ..,. -,,,, Y,;,, J,S;r <br />IVM <br />IOB ADDRESS <br />C1'0 -7 - Gi,4 t.: .v <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIETI <br />AIR COND UNITS —HP FA <br />BATHTUB <br />REFRIGERATION UNITS —HP EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIREDAC UNITS —TONNAGE CA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS—B 1 U MIA <br />DISWASHER <br />71ALL HEATERS —BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS—H T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGF HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADE RS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE — BAR E TC 1 <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SF TRACK <br />STREET SETBACK <br />RUN YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />ITT <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />3 <br />J <br />SIZE OF BLDG <br />NO OF STORKS <br />n1AX OCC TOAD <br />PLUMBING <br />FIRE ZONE <br />OASEMENT <br />I11.UR(A)A1S <br />I IRE SPRINKLERS <br />RFQUIREO <br />IYFS ONCE <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U BC <br />SEC NOW <br />2 BUILDING PUNS <br />TOTAL <br />T FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GRADINGIL XCAVAT ION b CLEARINGIGRUBRING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />L(- <br />9 1 79 <br />