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f'O EYPrown APPLICATION FOR <br />GITM OF <br />�..ONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DIVE IOPAII.NI SERVICES <br />CITY HALL 25"745 <br />EVERETT. WA9B201 ❑CO BINATION ❑ BUILDING ❑MECHA 1 AL ❑PLUMBING PERMIT NO. <br />OWN. AODRISS /OONI <br />MICHAKICAL <br />MAIL <br />h- <br />NUMBING CONTRACT OR <br />MAIL ADDRISS <br />CITY <br />CI ASS Of WORK <br />❑NEW ❑ADD17ION ❑ALTERATION ❑i;[PAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK__ ' - /I /17 <br />DIs_ cpry WORK ✓— w <br />fStoposigoost OF RUIIDINC <br />I HEREBY CERTIF THAT I HAVE READ AND EXAMINE THIS AP- <br />PLICATION AND NOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS 00 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 CO TRACTOR OR A RIZED AGENT DATE <br />X /L <br />Uwl OIXRIPIION Of PROPIRIY ISHOAN BIIOW ON AI/ACH IOW COPIIN <br />/��V'� <br />for LeLor LJO <br />TOR AD 'Sf / <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OL FIXTURE <br />FEE <br />NO. <br />TY OF EQUIPMENT <br />TEE <br />WATER CLOSET(IOLIFYI <br />AIR COND UNITS -HP IA <br />BATHTUB <br />REFRIGERATION UNITS-11 P EA <br />LAVATORY (WASH BASIN) <br />BOILERS -HP IA <br />SHOWLR <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK AL DISP <br />FORCED AIR SYSTEMS-B T U M EA <br />DISWASHLR <br />WALL HEATERS- -BTU M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS-B I U M <br />CLOIHtS WASHER <br />EVAPORATIVE COOLERS <br />WATER HIAIIR <br />CLOIHES DRYERS <br />URINAL <br />VI NTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-MINLEADERS <br />MFIAI FIREPLACE R CHIMNEY <br />SINK LSE RVIC(-BAR. ETC) <br />SUBTOTAL <br />SUBTOTAL 1 <br />PERMIT <br />E <br />PERMIT B <br />IDEAL FEE <br />s <br />TOTAL <br />FEE B <br />SIDE YARD St FLACK <br />STREET SETBACK <br />REAR YARDSEIBACK <br />PLAN CHICK NUMBIR <br />PLAN <br />Fit <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />Fits <br />VALUATION <br />FIL <br />TYPE Of CONS, <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />i <br />SIZI OF B:7G <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />TIRE ICFNI <br />i1RI ZONE <br />BASF MINI <br />T <br />91URIX)MI <br />IIRF SPRINKLIRS <br />REQUIRED <br />nYEs (]NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHICK LIST <br />PENALTY <br />UBC <br />SIC )ORO <br />Z BUILDING PLANS <br />TOTAL <br />3 FIRE HYDRANT <br />