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APPLICATION FOR <br /> 1M EY6Igr6Rn <br /> CITY OF L JNSTRUCTION e <br /> 1 <br /> everett PERMIT <br /> DEPT OF COMMUNITY DEVELOPMENT SERVICES <br /> CITY HALL 259-8I4S <br /> EVERETT.WA 98201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br /> DwNI1 MAn Auoxr Ss rm nr PHONE <br /> ��s Sc L. E ( 9�S 5 <br /> 7 ri`- <br /> AR OIC)OR DI vcN1A +IAD ADDRESS nn lip PHONE <br /> CINIIIAI CONTRACTOR MVI ADDRISS CITY lir PHONE LICENSE P <br /> MECHANICAL(CHIL IDR MAIL AUURISS (ITT Lir "ONE LICINSI8 <br /> PI l'MMING IONIR ACTOR MAIL ADDRESS (ITT llr PHONE LICENSE P <br /> CLASS Of"ORM <br /> ❑NEW []ADDITION ❑ALTERATION []REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br /> VALUATION Of"ORI <br /> S <br /> DIffRIRI WORK <br /> PROroi DE 9DJDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> LEGM DISCAIPTIONOE PROHRIT LSHOWN RIIO"'OR ATTACH FOUR COPDSI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK\VILE. BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> LOT_RIorx_of OR NOT TAE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLA EE 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 AUTHORIZfD AGENT DATE <br /> IORADDMM z , FI/C.Ke.77" X 'sial-' (/L2�� �L /7 / d <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of FIXTURE FEE NO, TYPE OF EQUIPMENT FEE <br /> WATER CLOSET ITOLIED AIR CONT) UNITS-HP [A <br /> BATHTUB Rf FRIGIRAIION UNITS-HP If, <br /> LAVATORY(WAS"BASIN) DOILIRS-HP FA <br /> SHOWER GAS FIRED AC UNITS-TONNAGE [A <br /> KITCHEN SINK A,DISP ICRCFIL AIR SYSTEMS-BTI. MIA <br /> DISWASHER "-AIL NI/Tl RS-BTU M <br /> LAUNDRY TRAY UNIT HIATIRS-BIU M <br /> CLOTHIS WASHER IVAPCRATIVF COULTAS <br /> WAIIR MATTA CLOTNIS DRYIRS <br /> URINAL VINTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLINC UNIT- C F M <br /> VACUUM BRFAKFRS STOVE <br /> ROOF DRAINS-RAINLEADIRS METAL FIREPLACE 6 CHIMNEY <br /> SINK(SERVICE-BAR.I TC' <br /> SJR TOTAL SUE TOTAL 6 <br /> PERMIT IF PERMIT 6 <br /> TOTAL fit 6 TOTALIT! A <br /> SIDE YARD SI I BACK STREET SETBACK 0.UR YAR051ILIAC K PLAN CHICK NUMBIR PLAN CHICK FEE <br /> rtf Rtr LTPT 40 <br /> USI ZONE LOT ARIA VACANT SITE <br /> ❑YES ❑NJ LEIS VALUATION f.' <br /> TYPE OF CONST OCCUPANCY GROUP NO Of DWELLING UNITS - <br /> 1, dDING 6 <br /> SIZE OF BLDG NO OF STORIES MAX OCC ILIAD <br /> PLUMBING <br /> EIRE ZONE BASEMENT NI U0.E)UMS REQUIRIRE E ID KlIRS TMICHANICAL <br /> IlYfS (INTY <br /> AMROVAIS BY ['AT[ OTHER <br /> I ENVIRONMENTAL CHICK LISTPI NALTY UBC <br /> M: TONS) _ <br /> 2 BUILDING PLANS _ <br /> TOTAL <br /> 2 (IRI HYDRANT <br /> 1 FIKF PROTECIION SYSTFM PERMIT VALMATION <br /> SVN(N PROPERLY VALIJAIED TIN THIS SPACE)THIS IS)OUR PERMIT <br /> S GRAOINGII XCAVAIION A CLE ARINGICRUBRING <br /> 6 DRAINAGE <br /> / ENVIRONMENTAL IMPACT STATEMENT <br /> IF HEALTH DISTRICT <br /> APPLICATION ACC BY PLANS CIIf CKFD BY APPK FOR ISSUANCE BY <br />