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1r <br />,No IF <br />'� APPLICATION <br />pSR �TOR <br />CITY or CONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA 98701 ❑COMBINATION ❑ BUILDING <br />ss <br />❑MECHANICAL ❑PLUMBING PERMIT NO. <br />PYPrrn <br />e <br />IF <br />PIUMNINC CONTRACTOR MAIL ADONIS% CITY ZIP PHONE LICENSER <br />CLASS Of WORK <br />❑IC� <br />NEW OVADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />s <br />O15 IRE ORk <br />PROPOSE ITLIST Of e1,111 1S <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 CONTRACTOR OR AUTHORIZED AGENT DATE <br />LLCM OISCRIPIION Of PROP) IY ISHOWN NIIOW OR AT AC OURCO I I <br />III <br />IOI,��eLocK�or '�' <br />I ,n+OnRI s C _ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />►EE <br />NO. <br />TYPE Of EQUIPMENT <br />FEE <br />WAI I R CLOSE T 17OL It TI <br />AIRCOND UNITS -HP IA <br />BATHTUB <br />REFRIGERATION UNITS —HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS —HP !A <br />SHOWER <br />GAS F )RED A C LINE TS—TONNAGE I <br />KITCHEN SINK 6 DISP <br />FORCED AIR SYSTEMS —BTU IHIA <br />DISWASHER <br />U <br />WALL HEAIERS—BTU . M <br />LAUNDRY TRAY <br />UNIT HUTERS—BTU M <br />CIOTHIS WASHER <br />EVAPORATIVE COOLERS <br />W AIIR NI ATER2 <br />CLOTHES DRYERS <br />C7 <br />(, I <br />URINAL <br />VINTILATION FAN <br />-c <br />JL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />l <br />± <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLE AD[ RS <br />AIL IAL IIRI PLACE L CHIMNEY <br />q <br />SINK (SERVICE —BAR. ETC I <br />SUBTOTAL <br />O <br />SUBTOTAL S <br />• <br />U <br />PERMIT <br />61 <br />PERMIT S <br />TOTAL FEE <br />S I <br />TOTAL <br />Fit L <br />SIUI SARO Sf TRACK <br />,5#c%-r <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHICK NUMMR <br />C T r� <br />C/ J <br />PIL <br />FEE �1' <br />CHECK FEE <br />RECEIPT NO <br />USE IONFf� <br />A� �2 <br />LOT AREA <br />2�si3 <br />VACANT SITE <br />OYES Lie <br />fill <br />VALUATION <br />EFT <br />TYPE Of CONS`T' <br />_•^ <br />OCCUPANCY GROUP <br />— <br />NO OF DWELLING UNITS <br />BUILDING <br />s <br />-03 <br />SIZE Of BLDG <br />Zyrl 7 <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIR! ZONE <br />BASEMENT <br />Lr✓ <br />flI UN(N)MS <br />FIRE SPRINKIIRS <br />RIQUI E <br />❑YES NO <br />MICHANICAL <br />2 <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHICK LIST <br />PENALTY <br />U XC <br />S[C ]BXNI <br />7 BUILDING PI ANS <br />TOTAL <br />) FIRE HYDRANT <br />A TIRE PROIICTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />% GRADINC,IXCAVAiION LCI URINGIGR UXIIINf, <br />A DRAINAGE <br />7 ENVIRONMENTAL IMPACT SIATIMENT <br />B HEALIH DISTRICT <br />APPLICATION ACC BY <br />PLANS CLACKED BY <br />V. & , <br />APPR FOR IswA�( I BY <br />I <br />91-79 <br />