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everett <br />APPLICATION FOR <br />CiNSTRUCTION <br />PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 2S48745 <br />EVERETT, WA'18201 COMBINATION ® BUILDING ❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />OWNER MAIL ADDRESS <br />(11, <br />eweir AV& <br />ZIP <br />9S go/ <br />PIIONI <br />3S� 2y9L <br />v//f 1 [ SIL _ ado/ .Tylsw <br />ZIP <br />PHONE <br />MCHOICTOROIMI,NIR MAIL ADDRESS <br />(Try <br />S.¢m c <br />:ITY <br />ZIP <br />PHONE LICENSE 1 <br />GENERAL COMP M 1 IR Mnll ADDRESS <br />M[C111NICbl CIINIRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />NUMBING CONTRACTOR MAII ADDRESS <br />CITY <br />ZIP <br />PHONE LTC[ ISEI <br />CLASS Of WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />❑DEMOLITION ❑FENCE <br />ppII <br />❑SIGN GARAGE ❑BUILDING RELOCATION <br />gI <br />VALUADON Or <br />1 1 Mal Oo <br />DISCRIRI WORK <br />He81s71D •6ITAlf o4 <br />I HEREBY CERTIFY TH)I.T I HAVE READ AND EXAMINED THIS AN <br />PRO;O pM OI xunUnl. <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEG.unscRlPDONorPRarIRnlMlos+Nnnlll+uxnnncnloDRav,llsl <br />PROVISIONS <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />LOT4j1_L3tj_0rOCKl2 elp 87= <br />r <br />OF <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 />108 ADD1RE SS <br />1 <br />A1 <br />-A AV/ / <br />7P iCs <br />X 1 V`i 1 <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />AIR COND. UNITS —HP EA <br />_ <br />WATER CLOSET (TOLIETI <br />REFRIGERATION UNITS—N P. EA <br />BATHTUB <br />BOILERS—H P. EA <br />LAVATORY(WASH BASIN) <br />.C. UNITS —TONNAGE E <br />GAS FIRED AA <br />SHOWER <br />fORCEO AIRSYSTEMS—B T.V M FA <br />KITCHEN SINK 6 DISP <br />WALL MEATfRS—R.T.U. M <br />DISWASHER <br />UNIT HEATLRS—B.T.SEE M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />_ <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT— C F M <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />ROOF DRAINS —RAINLE AM RS <br />SINK LSERVICF —OAR, ITC) <br />SUBTOTAL f <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />f <br />TOTAL FEE f <br />TOTAL FEE <br />STEEL ST I PACK <br />f <br />RI AR YARD SE L HACK <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />SID[YARU SI IIIACK <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT ARIA <br />VACANT SITE <br />TEES <br />VALUATION <br />FEE <br />2_ Z <br />ONES ONO <br />jYPE2j..CaNST` <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />f <br />M — ' <br />SIZE Of BLDG <br />NO Of STORIES <br />MAX OCC LOAD <br />6 V 3 <br />I <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />III IIRUIISIS <br />TIRE SPRINKLERS <br />REQUIRED <br />MECHANICAL <br />3 <br />AYES ONO <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PF NAI TY <br />UHC <br />IC MEW <br />Z. BUILDING PLANS <br />TOTAL <br />] TIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />W IdN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />S GRADINGIFX('AVATIONACIIANINGICRUHIIING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />6 HEALTH DISTRICT <br />C'LILA ITUN ALL III .^LASS 11111 KID III <br />nPPH InH r, . <br />