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LAR EwrgrPPB <br />CITY OF <br />APPI ICATION FOR <br />CGASTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2S9.9745 <br />EVERETT, WA9B2U1 PCOMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNIN _ MAII A,,".. 1, I• CITE IF PHONI ' J <br />ill i /Sic7I 1- . .1/ OCi Z,A <br />MAIL <br />LIMIKM CONTRACTOR MAIL ADDRISI (ITV ZIP PHON( IICINH I <br />MJ(HANICM CONTRACTOR MAIL ADORNS I III ZIP ?"ON[ IICINSI <br />Pit%IRINC CONTRACTOR MAIL ADORISS IITV ZIP PHONI LIC(NSII <br />CLASS OI WON, ,,--,,JJ <br />❑NEW ❑ADDITION LJALTERATION ❑REPAIR ❑DEJF-OLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />MIUAIION OI O_Kc- T, <br />DIMRIRI WON <br />/ / <br />_•N� `-.1 /r ,nnr-1� �rr 1. JJ'��rr�i /d)1/ ()FOIf <br />,." - ( v Ri <br />no us l or ounolNc <br />r • / <br />uul oHalPnoNa v1lorDlfr alloWN RuoW ON Much IouR corns) <br />TOT _MaK_of - <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 NIRACTOIE OR AUTHORIZED AGENT DATE <br />1 I � y <br />TOP AD. AHS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TTPE OF EQUIPMENT <br />FEE <br />WATER CLOS' T ITOLIEII <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRIOERAIION UNITS —HP EA <br />LAVATORY (WASH BASINI <br />BOILf RS—H P EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK S DISP <br />fORCED AIR SYSTEMS—B T U MIA <br />DISWASHIR <br />WAIL PLATE RS—B T U M <br />LAUNDRY TRAY <br />UNIT HIAT[RS—BTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CIOTHES DRIERS <br />URINAL <br />VENTILATION MN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS — RAINLI AD[ ITS <br />MFTAI FIREPLACE A CHIMNEY <br />SINK ISE RVICF — BAR, E PC' <br />SUB TOTAL <br />SUB IOTAI S <br />►EAMIT <br />S <br />PERMIT S <br />TOTAL TEF <br />S <br />TOTAL FEE S <br />SIDE I ARD SI TRACK <br />SIRELT SITBACI' <br />REAR YARD SITBACK <br />PLAN CHICK NUMBER <br />PLAN <br />/f! <br />CHICK CEITFF <br />RFC[IPT NO <br />USE ZONE <br />LOT ARIA <br />VACANT Sill <br />DYES LINO <br />IF[S <br />VALUATION <br />/EI <br />TYPE OF CONSI <br />OCCUPANCY GROL" <br />NO Of DWELLING UNITS <br />BUIIDINC <br />S <br />SIZE OF BLDG <br />FIRE ZONE <br />NO OF STORIES <br />BASEMENT BIDR(x) <br />MAX OCC TOAD <br />FIE PEINNKLERS <br />",IS FIND <br />PLUMBING <br />Mf CIV VICM <br />APPROVALS <br />RT <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHECK LIST <br />PENALTY <br />UCB <br />SFC lO] NI <br />2 BUILDING PLANS <br />TOTAL <br />J IIRI HYDRANT <br />R FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPIRLI VALIDATED UN THIS SPACEI THIS IS YOUR PERMIT <br />- E <br />S GRADINOII XLAVATION L CLE ARINGIDRUBBING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />S HE 4LIH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />V. r, <br />