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:�.Ey.,o�,� A�'PLICAT�ON F(3tt <br />��TM�F �,ONSTRUCTION <br />everett PERMIT <br />D;.PT OF COMb1UNITY DiVELOPMENT SERVICES <br />CITY HALL 259�8745 <br />EVERETT, WA98201 �COMBINATION � BUILDING ❑MECHANICAL ❑PLUMSING PERMIT NO. <br />OWNEft M�IIAUOXHS CI1Y ZIP PNONE <br />WA�r� N 3os s� �so S 7'—� si �ue,•�T r,��4 _ as8-isys <br />RACI9R <br />ri c.mrvc cor+i <br />M�II <br />AIAIL <br />CIiY <br />ZIP <br />tICEnSi I <br />C1A51 Of AYORK - <br />❑NEW ❑ADDITION ❑ALTERATION ❑BEPA�R ❑DEMOLITION ❑FENCE ❑SIGN ❑CARAGE ❑BUILDING RELOCATION <br />VAIUAi'.ONpO�f WORF <br />f F/.i���. Df� <br />UFS�CNIflI \VORK � <br />nentotlG � iNSTA%I /✓Cu� a0 �oJ <br />PROPOSLUUSf OI N6:l�ING I HERE6Y CERT�FY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />imnio�scaivriovorraorFarviv�oN�euowoRnirnrnrouamvnsi PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPf <br />OF WORK WILL BE COMPLIED WITH WHETHER SFECIFIED HEFEIN <br />l01 �PLOCK_�Of OR NOT. THE GRANTING OF A P� RMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />.�e ID �Ar� DiJ• 2 ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />��K pe(� D- o„ - ��T. /3o S4� /� SG ��� SIGNATURE OF CONTR�CTOR Oft AUTIIORIZED AGENT DATE <br />ioxnooutss y� 'l� /� __ _ �^��� Si� <br />.430`% :'�S% �Gtt.�r// x � ���/i �i oil•.»� <br />PIUMBING <br />NO. TYPE OF FIXTURE <br />WATER ClOSET (T011Efl <br />pATMTUB <br />LAVATORY�WASM BASIN) <br />SHOw(R <br />KITCHfN Slf.'K d DISP <br />DISWASHEk <br />UUNOftY TNAY <br />CLO7HE5\YASHER <br />WAiFR MEATER <br />URINAL <br />DRINKINC FOUNTAIN <br />FlOOr2 ORAIN <br />VnCUUA1BRFnKERS <br />NOOF DRAINS—HAINLEADE85 <br />SINK �SERVICE—BAR, ETC I <br />SIDF Y�RO SL <br />USF ZONE <br />T /P[ OF CON'. <br />SIZE OF NL�G <br />FIRE ZOYE <br />SUB TOt'AL <br />�EMMIT <br />'.OUI 1 EF <br />STREC7 SCTO�CK <br />LOT AREn <br />OCCUPANCY GROUP <br />NO OF $TORIES <br />BASEMENT BLUR <br />AP^IIOVAlS <br />1 ENVIRONMENTAL CHECK lIST <br />2 BUIL�ING �IANS <br />7 FIRE HYURANT <br />� FIRE PROTECTION SYSTFM <br />5 GRAOIr+CIfYUVAT10N8QEARINGIGRUNNIr+G <br />6 DNAINAGF <br />7 ENVIRONMENTALIMPACiSTATEMENT <br />E HEALTH D�STHICT <br />FEE NO. TYPE OF EQUIPMtni <br />AIR CONO U41T5—HP U <br />REFRILERATION UNITS—H P EA <br />DOIlERS—H P EA <br />GAS FIRED AC UNITS—TONNACE EA <br />fORCED AIN SYSTE�15—B1 U M <br />WALLMEATER$—B7U M <br />U41i HEATERS—E11 U M <br />kvAPORA�IVE COOLERS <br />CLOTHES DRYFRS <br />VFNTIIATION FAN <br />RANGFHOOD <br />AIRHANDLINCUNIT— CFM <br />STOVf <br />METAI FlRFPUCE 6 CHIMNfY <br />�3 <br />RUR Y.\ftD <br />VAUNT $ITF <br />❑YES ❑NO <br />YO OF DWfIL�NG <br />MA% UCl LU�U <br />FBE SPRINKLfRS <br />REQUIRED <br />C7YF) ❑NO <br />er DAiE <br />APPIIC Ulnv ACf AY ���45 f.HFCYEU [1Y I nPPR fOR ISSUAM.t NY <br />FEE <br />SUlTOTA1 f <br />�ERMIi s <br />TOTAL FFf s <br />PIAN CH[CK NUMOER PUN CHFCK FEE <br />FFF RECFIPi NO. <br />v�sc VAWAiION FFE <br />6URDING s�,� 0 O 0� <br />PIUMfi1NG <br />IdECMANIUL <br />OTNER <br />UBC <br />PENALTY SEC JOJ�a) <br />TOTAI <br />�[RMIT VALIDATION <br />WHkN PROPERLY VALID�T[D ON TMIS SPACf� THIS IS YOUR PERMR <br />� <br />