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APPOCATION FOR <br />C.JNSTRUCTION <br />everett PERMIT <br />W <br />OTTE Of CUAIMUNIIY ULVLLOPMENT SERVICE S <br />CITY HALL 2SM74S <br />EVERETT. WA9B201 COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />MAIL. AUDRIu .al CITY 711• PNnNI /f <br />OWNER A . ..01 _ - GA.._. 7 i IF .i. N9L <br />1/ <br />ZIP PIIUNL <br />LICINSI . <br />f.INlRAI CONIMCIUR <br />MAIL ADDRISS <br />CITY <br />Clly LIP %ION[ <br />IICFN51 IF <br />MECHANICAL CONTRACTOR <br />MAIL ADDRISS <br />CITY ZIP %ION[ <br />IICINSI IF <br />PLUMBING CONTRACTOR <br />MAII ADDRISS <br />CI SS Of WORK <br />flames 171AnnIT1ON ❑ALTERATION ❑REPAIR <br />VALUAT ION Of WORK <br />f <br />Df SCRIM WORK _ <br />PROMS[ D USI OI <br />LEGAL DESCRIPTION Of PROPERLY FSTIOWN RI LOW OR ATIA04 FOUR CO%nl <br />LOT%f 0 MOCQ#22~ Pin helISr PIE" <br />FOR ADORI SS ••It/ <br />;L.:io / %Y <br />PLUMBING <br />NO. TYPE OF Fi <br />SS'ATFR CLOSET (TOW If 11 <br />BATHTUB <br />LAVATORY TWASH PAST; <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISWASHER <br />LAUNDRY TRAY <br />ROOF <br />ZONE <br />TYPE <br />TC I <br />SUB TOTAL <br />PURSUE f <br />TOTAL FEE f <br />HET SEIBACK RI <br />LOT AREA <br />AP►ROVAL$ <br />'I i ENVIRONMENTAL CHECK LIST <br />Z BUILDING PLANS <br />E FIRE HYDRANT <br />A LIRE PROTECTION SYSTEM <br />S GRADING/EXCAVATIONRCIEARINGIGRUHRING <br />6 DRAINAGE <br />1. ENVIRONMENTAL IMPACT STATEMENT <br />6 HEALTH DISTRICT <br />APPLICATION ACC BY I PIANSCHECKID TEE <br />9.1 79 <br />VACANT SITE <br />❑YES ❑NO <br />BY <br />APPR FOR <br />❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />oli 41r" arom #,Ilk, <br />I HEREBY CERTIFY THAT ' 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 />MECHANICAL <br />NO. TYPE OF EQUIPMENT <br />AIR COND UNITS-" P EA <br />RIFRIGIRATIONUNITS-HP [A <br />ROVERS -HP. [A <br />GAS FIRED A UNITS -TONNAGE FA <br />IORCFDAIR SYSTEMS -BTU. N <br />WALL HEATERS-R T U M <br />UNIT H[ATIRS-B E U M <br />EVAPORATIVE COOLERS <br />CLOTHES URYERS <br />VENTILATION • IN <br />RANGE HOOD <br />AIR HANDLING UNIT- C F M <br />METAL <br />'BACK <br />PLAN CHICK N <br />1 <br />NG UNITS <br />ID <br />RS <br />WATT <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />BY <br />'LACE A CHIMNEY <br />SUBTOTAL S <br />PERMIT S <br />TOTALTEE S <br />R PLAN CHECK FEE <br />fit RECEIPT NO. <br />VALUATION IF <br />f <br />UBC <br />SEC. BBXa) <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED WIN THIS SPACE) THIS IS YOUR PERMIT <br />