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the Enrpmn <br />GTY OF <br />APPLICATION FOR <br />everett `3NPE RUC <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OY:NIX MAIL ADDRESS CITY ZIP I•IU'•J <br />p`Ai-c; \c S -5c1A�E �4s// (o.l� Si ;1rnY•,�iX7 e, F J w <br />ARCHITECT OF DESICNIR MAR ADDRESS CITY ZIP PNO41 <br />GENERAL CONIRACTUR MAIL ADDRESS CITY ZIP PHONE IICINSfR <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />IICINSI F <br />�\ <br />r1UMBINO CONTRA CEW <br />MAIL ADDRESS <br />CITY <br />LIP <br />PHONE <br />11C145F F <br />LASS Of WORK <br />KNEW []ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE CBUILDINC RELOCATION <br />VALUATION Of WORK <br />DISCRIRI WORK p� <br />PROPOSED OF Of BUILD BUILD NG <br />\�cS' <br />LEGAL DFSCRIPTIDN Of IBC%ILLY [SHOWN BELOW OR ATTACH YOUR COPIES)PROVISIONS <br />LOT —BLOCK —OF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO Br TRUE AND CORRECT ALL <br />OF LAWS AND ORDINANCES GOVERNING THKTYPE <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 CONTRACTOR OR AUTHORIZED AGENT DATE <br />' - <br />X <br />LOB ADDRESS / l [ <br />a. // ie /,�5+ - q -, R C ZKfJ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOLIFT) <br />AIR COND UNITS -HP EA <br />BATHTUB <br />REFRIGERATION UNITS -HP FA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP EA <br />SHOWER <br />GAS HREDAC UNITS-IONNACE LA <br />KITCHEN SINK S DISP <br />FORCED AIR SYSTIMS-BTU MIA <br />DISWASHER <br />WALL HEATERS-9IU M <br />LAUNDRY TRAY <br />UNIT HEATERS-111 U ATCLOTHES <br />WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRVFRS <br />URINAL <br />VI NTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BRIAKIRS <br />SIOVf <br />ROOF DRAINS - RAINLF AVE ITS <br />META' FIREPLACE &CHIMNEY <br />SINK (51 RVICI -BAR. 1 Tr) <br />SUS TOTAL <br />SUS TOTAL S <br />"LIMIT <br />S <br />PERMIT S <br />TOTAL RE <br />S <br />TOTAL FEE S <br />SIDE YARD S1 TRACK <br />STR1I I SE TRACK <br />BEAR YARD SETBACK <br />PLAN CSILCK NUMBER <br />PLAN <br />111 <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />I nT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VAlUAl10N <br />FIE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />BUILDING <br />F <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />HASIMENT <br />ITT DRff)M% <br />FIRESPRINKLERS <br />YF5 FIND <br />MI(11ANIUl <br />APPROVALS <br />SY <br />DATE <br />OIHIR <br />1 INVIRONMINTAL CHECK LIST <br />PENALTY <br />II BC <br />SFC Il Ral <br />7 BUT[ DING PLANS <br />TOTAL <br />S FIRE HYDRANT <br />A FIRE PROIICIION SYSTEM <br />S GRADINGIIXCAVSTION S CILARINGIGRUBRING <br />PERMIT VALIDATION <br />WHEN PROPERLY VAT IDATID TIN THIS SEA([) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 INVIRONASFNIAL IMPACT STAUAIEHT <br />S HEALTH DISTRICT <br />APPR TOP ISSUANCE BY <br />AePIICATION ACC BY <br />PLANS CHf CKID BY <br />9179 <br />