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APPLICATION FOR_ fY <br /> CITY OF <br /> F OZONSTRUCTION <br /> CI <br /> everett PERMIT <br /> DEPT OF COMMUNITY DEVELOPMENT SERVICES <br /> CITY HALL 259-5745 <br /> EVERETT,WA9S201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br /> OWNER _t .MAIL ADDR SS / TTY ZIP O� PHONE _ _ <br /> 17_ � , SY - <br /> ARCNI C/OR DI MALI ADDRESS CITY ZIP PHONE <br /> GENERA CONTRACTOR MAI AO MSS (IIY LP PHONE ll[INS! <br /> ' r <br /> MECHANICAL CONTRACTOR it DRESS (IlY ZIP PHONE IICINSII <br /> t 111 ZIP PHONE LICENSE 1 <br /> HUMBIN(:CONTRACTOR MAIL ADONIS$ MM <br /> c❑LASS OF NEWwoNNNADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN )B.IGARAGE ❑BUILDING RELOCATION <br /> VALUATION Of WORK <br /> I # ' -el6 <br /> DESCRIBE WORK <br /> noro DusF or e I NG r 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> 2 CI. PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> LEGAL URCRIPT1ON Of PROPERTY ISHU lel woN ATTACH TO pits) OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> Lot BIOCK_a OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE <br /> AUTHORITY <br /> ATE OR LOCAL LAW GULATING CONS RI <br /> ONS OF <br /> A YOTHERSTREGULATING <br /> OR THE PERFORMANCE OF CONSTRUCTION, <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> Loa mOR s X t <br /> MECHANI L <br /> PLUMSING FEE <br /> NO. TYPE OF FIXTURE FEE NO. iiPF OF EQUIPMENT <br /> AIR COND UP'ITS-HP EA <br /> WATER CLOSET ITOIRTI <br /> REFRIGERATION UNITS-H P FA <br /> BATHTUB <br /> BOII[RS—MP FA <br /> LAVATORY IWASN BASIN) <br /> GAS FIRED AC UNITS—TONNAGE EA <br /> SHOWER <br /> FORCEO AIR SYSTEMS—BTU MEA <br /> KITCHEN SINK 8 DISP <br /> WALE HEATERS-1111U M <br /> DISWASHER <br /> UNIT HEAIf Rf—BTU M <br /> LAUNDRYTRAY <br /> EVAPORATIVE COOLERS <br /> CLOTHES WASHER CLOTHES DRYERS <br /> WATER HEATER <br /> Vf N11LA1ION TAN <br /> URINAL RANGE HOOD <br /> DRINKING FOUNTAIN <br /> AIR/IANDIING UNIT— CFM <br /> FLOOR DRAIN S10Y1 <br /> VACUUM BREAKERS <br /> METAL FIREPLACE 6 CHIMNEY <br /> ROOF DRAINS—RAINI[ADIRS <br /> SINK ISERVICE—BAR.ETC I <br /> FLUS TOTAL 1 <br /> SUB TOTAL PERMIT 1 <br /> PERMITTOTAL 1 1 <br /> RF S TOTAL FEE <br /> PLAN CHECK TEF <br /> SIDE YARD SETBACK STREET S[TPACY RIAR YARD SI TRACK PLAN CHECK NUMBER MIECHANICAL <br /> RECEIPT NO <br /> USE ZONE IOT AR VACAN Ill fig <br /> lievis ONO <br /> 1 <br /> TYPE OF CONS OCCUPANCY GROUP NO OF DWELLING UNITS <br /> % <br /> SIZE OF BLDG NO OF STORIES MAR OCC LOADTIRE 20NF OASTMfNT NI DRWMS FIKEA►RINKLERSREQUIRED _ <br /> C)YES ONO <br /> APPROVALS ST DATE OTHIR <br /> UBC <br /> 1 ENVIRONMENTAL CHICK LIST PENALTY SEC SORT) <br /> 2 BUILDING PLANS TOTAL <br /> FIRE HYDRANT <br /> PERMIT VALIDATION <br /> 4 TIRE PROIFC1IOn SYSTEM WH IN PROPERLY VA/IDATFD LIN THIS SPACE)THIS IS YOUR PERMIT <br /> S GRADINGIIRCAVATIONLCLIAKINGIGRUBRING <br /> 6 DRAINAGE <br /> 7 ENVIRONMENTAL IMPACT STATEMENT <br /> B HEALTH DISTRICT <br /> APPLICATION ACC BY PLANS CHECKED BY APPR FOR ISSUANCE By <br /> 9.1.79 <br />