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IM F.rsrgr"n <br />CITY OF <br />APPLICATION FOR <br />.:ONSTRUCTION <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.874S <br />EVERETT, WA 98201 COMBINATION ❑BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAII ADDRISS IM1 ; n' PHONE <br />�d( <br />qr� r t9 <br />'dSl(\41.811'�. <br />m <br />4 <br />NIRALCONIRACIOR MAIL ADDRISS CITY /W PHONE LICINSEI <br />g OW4 ei <br />MICHANICAL CONTRACTOR MAIL ADORFSS CITY /IP PHONE LICINSTI <br />NUMRINI: CONTRACTOR MAR ADDRISS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />VNEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELO=ATION <br />VALUATION Of WORK <br />yeIL <br />I <br />/`Zi.t>RK // <br />7 <br />ci0 <br />9RDPd�OSI0 USI 01 BUILDING <br />-\%.7T" <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 r_ DATE <br />v ' / /J�or /�L?- l_O� <br />X! ' (:: (i -1i1C0 UY v 0 <br />IICAL DISCRIPTIONOF PROPIRTY(SHOWN RIIOW OR ATTACH FOUR COPYIST <br />TOT —BLOCK —OF <br />�[011ADURI, <br />r i i 1 y f� 1, �� /c <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />II[ <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />A A I I R I OSET (TOT IF III <br />AIR COND UNITS-H P FA <br />BATHTUB <br />REFRIGERATION UNITS -HP [A <br />_ <br />I AVATORY(WASH BASIN) <br />BOILERS —HP EA <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHI N SINK B DISP <br />FORCED AIR SYSTEMS—B T U MIA <br />DISWASHIR <br />WALL HIATFRS—BTU M <br />LAUNDRY TRAY <br />UNIT HIAIIRS—IL I U M <br />CLOTH[$ WASHER <br />FVAPORATIVI COOIIRS <br />WATER NIAIFR <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />I IOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BRFAKIRS <br />STOVE <br />ROOF DRAINS—RAINII AM RS <br />ME IAL FIRFPLACI & CHIMNEY <br />SINK ISrEf—BAR I11 <br />SUB TOTAL <br />SUB TOTAL S <br />P[RMIT <br />S <br />PERMIT S <br />_ <br />TOTAL Fit <br />E <br />TOTAL FEL S <br />SIDE YARD SETBACK <br />STRIET SETBACK <br />REAR YARD SIIBAC K <br />PLAN CHECK NUMB) R <br />PLAN <br />Fit <br />CHECK FIE <br />RIC[BIT NO <br />USE ZONI <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />►[ES <br />VALUATION <br />FEE <br />TYPE OF C'ONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF PLUG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIR) ZONE <br />BASIMINI <br />BI DROOMS <br />FIR[ SPRINKLIRS <br />REQUIRED <br />❑YES ONO <br />MICHANICAL <br />APPROVALS <br />BY <br />OATS <br />OTHER <br />1 ENVIRONMENTAL CHICK LIST <br />PINALTY <br />U BC <br />SIC 10XR1 <br />7 BUILDING PLANS <br />TOTAL <br />S FHD IIYDAANT <br />A FIRE PROTI CI ION SYSTEM <br />S GRADINGII XCAVATION B CLI ARINOCRUBBING <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED DN THIS SPACE) THIS IS YOLIN PI Rnu 1 <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HIALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APP11 FOR ISSUANCE BY <br />II <br />9-1-79 <br />