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TAM EYrrprPlR <br />CITY OF <br />APPI (CATION F1 <br />everett CGF ERMITTIO <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2S9.8745 <br />EVERETT. WA 98201 <br />❑COMBINATION ❑ BUILDING <br />❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />OWMIR <br />J MAIL .11[1MIW r <br />CITY <br />!IP <br />?"ONE <br />lrrr; <br />t. <br />ur...... nlz Ann <br />MAIL AEFORISS <br />CITY <br />COP <br />PHONI <br />(:I NI RAI COVIMC FOR MAIL.0OXISs IIIY lip PHONI IKINbE1 <br />MIT IIAM('A[ CONTRACIUR "Ilk AODRI'.S I11, !IP PHONI UCINSI I <br />PITMRINC CONTRA( FOR vMI AOORIW Clh !IP PHONE IICINSII <br />11 All OF WORK rPa�tt <br />❑NEW ❑ADDITION L'7ALTk RATION ❑REPAIR ❑DEMOLITION ❑IENCE ❑SIGN []GARAGE❑BUILDINC RELOCATION <br />YAIVADrn( of woe%- C, <br />om RIRI WOR ( j / / <br />uy <br />rlloro/u/q usl rn/ nwlvinc —� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />IICAI DISCRIPOO+Of PROPIRIY ISHO%N RIIO'A OR AIIAIl11()UR COPIISI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLII D WITH WHETHER SPECIFIED HEREIN <br />COI _01OCK__01 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 <br />/O/fj.ONTRACTO/nf ORAAUTH/Q/RIZFD AGENT DATE <br />OR 40DR1 is <br />PLUMBING <br />MECHANICA <br />NO. <br />TYPE OF FIXTURE <br />FEF <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WAIIR CLOSFT(TOLIIT) <br />AIR COND UNITS -HP EA <br />BATHTUB <br />RHRICIRAI ON UNITS -HP [A <br />LAVATORY (WASH BASIN( <br />ROILFRS-H P EA <br />SHOWER <br />CASHREDAC UNITS-IONNAGE[A <br />KITCHEN SINK R DISP <br />FORCED AIR SYSTIMS-B T U M EA <br />DISWASHIR <br />WALL HIATFRS-BIU M <br />LAUNDRY TRAY <br />UNIT HIATIRS-BIU M <br />CLOTHES WASHER <br />IVAPORATIVE CODIFIES <br />WATER WATER <br />CIOIIIFS DRYERS <br />URINAL <br />VI NTILA71ON FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BRLAKIRS <br />STOVE <br />ROOF DRAINS -RAINLI ALTERS <br />METAL FIREPLACE 8 CHIMNEY <br />SAK ESI RVICE - BAP. FTC I <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT <br />I <br />PERMIT S <br />TOTAL F11 <br />S <br />TOTAL FEF S <br />SIDE YARD SETBACK <br />SIRF(T SETBACK <br />RIAR YARD SI TBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FIE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT Silk <br />OYES ONO <br />F1FS <br />VALUATION <br />T!F <br />TYPE Of COAST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />HUIIDING <br />S <br />SIZE Of BLDG <br />FIRE ZONE <br />NO OF STOR ITS <br />BASF MEAT Ilk OR(N)MS <br />MAX OCC LOAD <br />FIRE SPRINKLERS <br />RIQUIRID <br />YIS ONLY <br />PLUMBING <br />MFCHANICAl <br />APPROVALS <br />BY <br />DAL[ <br />OTHER <br />1 ENVIRONMENTAL CHICK LIST <br />PENALTY <br />URIC <br />SIC )ON$) <br />7 BUILDING PLANS <br />TOTAL <br />S FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />5 GRADINGIIXCAVATION A CLIARINOCRUBBING <br />PERMIT VALIDATION <br />WHEN PROPIRLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />IF INVIRCRIl AL IMPACT STATEMENT <br />8 HEALTH DISTRICT <br />APPLICA110N ACC BY <br />PLANS CH[CKFO BY <br />APPR FOR ISSUANCE BY <br />V C. <br />91 79 <br />