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HHE EYNIPIND APPLICATION FOP <br />e <br />CITYoP OF t CONSTRUCTION I` <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES PERMIT <br />16 <br />CITY HALL 259�6715 <br />EVERETT. WA9BZo1 ❑COMBINATION ❑ BUILDING 13MECHANICAL ❑PLUMBING PERMIT NO. <br />OwN1R MMI ADDRESS <br />CITY ZIP IIIONI <br />JDHN TLLffAL Up 2001 63 0.0 STREET Fvr-aeTT 9g203 3SS-6040 <br />ARCHIIICI OR DI SIIINIR MAIL ADDRESS CITY ZIP PHONE <br />CENTRAL CONTRACTOR MAIL ApDq SS CITY ZIP PHONE <br />LICENSI I <br />ur PHONIC IICE NsFI <br />NUMBING CONIRACT'SR MAIL ADDRESS CITY ZIP PHONI LICENSE I <br />CI ASS Of WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUHDINC.. RFInr.TInN <br />DESCRIBE WORK <br />XAIbTALF_ATIN.I nC LIn.., O.IA K\..1. .. <br />OF BUBDING <br />LEGAL DISCRIPIION OF MOPIRIY DNOWN BIIOW OR ATTACH TOUR COPIISI <br />101 _ BIOCK _ OI <br />c V/G <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AN <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 />IOK ADDM;ass <br />7 6'3.� <br />x LLI 1z6eSz <br />PLUMBING <br />MEC ANICAL <br />NO, <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OE EQUIPMENT <br />FEE <br />SSATIR CLOSE T 11OLIF If <br />AIR COND UNITS - HP IA <br />— <br />ISATHTUR <br />REFRIGERATION UNITS -HP [A <br />I AVATURY(WASH BASINI <br />FICHURS-HP [A <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHIN SINK I. DISP <br />FORCID AIR SYSTEMS -BTU MIA <br />UISWASHER <br />WALL HIATERS-BTU M <br />' <br />L AUNDRY TRAY <br />UNIT HIATERS-BTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANCE HOOD <br />I LOOR ORAIN <br />AIR HANDLING UNIT - C F M <br />S'ACUUM RRf AKI ITS{� <br />STOVE <br />ROOF DRAINS-RAINLI AOI ITS <br />AIITAI FIREPLACE 6 CHIMNFV <br />SINE. SIRVICf-BAR,(ICI <br />SUN TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT B <br />TOUT Fll S <br />TOTAL FEE S <br />IDF YARD St BACK <br />STREET SIIBACK <br />RIAR YARD SETBACK <br />PLAN CHICK NUMBER <br />PLAN CHICK III <br />Fit RI I I CPT NO <br />IS[ ZONE <br />LOT AREA <br />VACANT SITE <br />OYFS ONO —] <br />)TES <br />VALUATION <br />ILL <br />YPl OF CONS) <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />APPROVALS <br />1 ENVIRONMENTAL CHf CK LIST <br />Z BUILDING PUNS <br />5 FIRE HYDRANT <br />A FIR[ PROTECTION SYSTEM <br />S GRADINGII XCAVOIONILCLEARINGIGRUBRING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />6 HULTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />MAX OCC <br />IBUILDING I S <br />PLUMBING <br />1IYF SI1N0 I MECHANICAL <br />BY I DATE I OTHER <br />BY <br />PENALTY USE: <br />SEC7011R1 <br />TOTAL <br />P[NMIT VALIDATION <br />WHIN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />R <br />91-19 <br />