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the EWFrpmn APPLICATION FOR <br />CITY OF CONSTRUCTIOI. <br />everett PERMIT e <br />DFPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2SM745 <br />-- EVERETT WA9E201 EICOMBINATION ❑ BUILDING ❑MECHANICAL LIPLUMBING PERMIT NO. <br />OWMIR ,,,. MAIL ADOR/SS ("I RIP PHONE <br />4eCol. /5,75-74t` Eucectf 9'8603 353-/040 <br />ARCHITECT O OISICNIR MAIL ADDIIISS CT ZIP PHONt <br />-. __. _.. ...�... ..�..... 1.2,:2p <br />S;dl j,T E Oo.VS•f CO.f `_ SAJO /rEonTi; l 98,790 S'66-y61 G 74-Al -CL <br />PLUMBING CONTRACTOR MAIL ADDRISS CITY ZIF PHONE LICENSE <br />CLASS Of WORK <br />❑NEW ❑ADDITION ❑ALTERATION REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Or WORK <br />S co <br />_ 3800. <br />DESCRIBE WORK ff�S <br />Re ' Roo u 4?w 9 PPAP Pone IN G LA HcKS <br />PROPOSED USE Of SURI)INC <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 />X K "1/(� /—oqe-8 <br />` N._/ �Q <br />UICM DESCRIPTION OF PROPERTY DHOWN BELOW OI ATTACH LOUR COPHa <br />LOT Z_elocK =_or C <br />IOBAODREss 2 s - ?N �ti � <br />Is �Elae7� LJn. 9Hoo3 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />Fit <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATIR CLOSET ITOLIETI <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS—H P [A <br />LAVATORY (WASH BASIN) <br />I <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS—TONNAGE[A <br />KITCHEN SINK 6 DISP <br />FOAC[O AIR SYSTIMS-B T U M EA <br />OISWASHIR <br />WALL HEALERS -BTU M <br />LAUNDRY TRAY <br />UNIT HEALERS-11 T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WAIER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VINIILATION FAN <br />DRINKING FOUNTAIN <br />RANG[ HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLIADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE —BAR, FTC) <br />SUB TOTAL <br />STIR TOTAL f <br />PE%MIT <br />I <br />FILMIC / <br />TOTAL RE <br />6 <br />TOTAL FEE $ <br />SIDE YARD $[TBACK <br />SIRI[T SETBACK <br />RLAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />fit <br />CHECK FEE <br />R[CEIPf NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEE$ <br />VALUATION <br />FIE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />1 <br />SIZE OF BLDG <br />NO Of STORIES <br />MAX OCC IOAD <br />PLUMBING <br />FIRE ZONE <br />• <br />BASEMENT <br />RI DROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />r'YI S FiNO <br />MICHANICAt <br />APPROVALS <br />$Y <br />OATI <br />OTHER <br />1 ENVIRONMtNTALLHICKIISI <br />PINALTY <br />UBC <br />SIC SOXII <br />Z BUILDING PLANS <br />TOTAL <br />T FIRE HYDRANT <br />A TIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PIRMIT <br />S GRADINGIIXCAVAIION 6 CLIARINGIGRUBRING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACI SIATIMENT <br />6 HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHICKED BY <br />APPR FOR ISSUANCE BY <br />9.1-79 <br />