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APPLICATION FOR lYBIBII <br /> te:oeromD .:ONSTRUCTION Pi <br /> everett PERMIT <br /> I DEPT.OF COMMUNITY DEVELOPMENT SERVICES <br /> CITY HALL 259•874S <br /> EVERETT.WA 96201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br /> OWNIR �/ MMI ADDRESS Inv /� zip PHONI <br /> �J uy'4� %!;tr <br /> ARC HICT OR DISICNIR MAILAWRISS CITY !P HONI �. <br /> GINIRALCONIRACTOR MAIL ADDRESS Ell, lip PHONI LICINStI <br /> MICHANICAL CONTRACTOR MAIL ADONIS$ City lip PHONI LICENSE <br /> PIDMAING CONTRACTOR MAIL AOORI SS CIES nr PHONE IICINSII 1 <br /> CI AS$OI WORK <br /> ❑NEVV ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑%ARACE ❑BUILDING RELOCATION <br /> %MDATIDN Of WORK i <br /> $ c' ?, ©' <br /> OHCMBI WORK <br /> PRDi usT DI Rul1DiNG ' ' 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> IIGAI DISCRIPIION Ci HOPI v ISHOWN RI IOW OR AIIAC NIOOR CONISI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> LOT -< Bimili—DI OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> Cj $ vI — ,� L — ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUR)Of CONTRACTOR OR THORIZEO AGENT DATE <br /> IOIADDRISS �- ''/ <br /> 7 x <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE FEE I O. TYPE OF EQUIPMENT FEE <br /> WAIIR CLOSET(TOLIFT) AIR COND UNITS—HP [A <br /> BATHTUB REFRIGERATION UNITS—H P EA <br /> I AVATORY(WASH fIASINI BOILIRS—HP LA <br /> SHOWIR GAS FIRED AC UNIIS—TONNAGI EA <br /> KITCHEN SINK 6 DISP FORCED AIR SYSTEMS—B T U MEA <br /> DISWASHIR WALL HEATERS—BTU M <br /> LAUNDRY TRAY IV UNIT HtAURS—BTU M <br /> CLOTHES WASHER tVAPORATIVE CO01IRS <br /> WAIIR HEATIR / CLOIHIS ORYt RS <br /> URINAL <br /> VENTILATION FAN <br /> DRINKING FOUNTAIN RANCE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C F M <br /> VACUUM 9R[AKINS S10VE <br /> 1 ROOT GRAINS—RAINLFADIRS MITAI FIR[PLACI&CHIMNEY <br /> SINK OF RVICI—BAR.ETC] <br /> I�i <br /> SUBTOTAL SUI TOTAL F <br /> FttMIT S MRMIT _ 1 <br /> TOTAL FEE S TOTAL FET IF <br /> SID[ YARDS[TRACK STREEISETRACK RIAR YARD$I TBACK PLAN CHECK NUMBER LAN CHECK I <br /> f[[ RECEIPT <br /> / NG <br /> USFN NE LOT AREA VACANT SIZE Fits VALUATION TEF <br /> ZO <br /> —( / DYES JRNO <br /> FC <br /> TYPE O1 OCCUPANCY GROUP NO OF OWIILING UNITS <br /> �' 2... 3 BUILDING F/L� (�[ . , 70 <br /> SIZE OF BLOW, NO Of 51UNI[S MAX IXC LOAD <br /> PIUMBING <br /> FIRE ZONI BAS[MINT RI 0010015 FDH S RINKLIR$RIQUIIMICHANICAI <br /> - No 3 nrfS O _ <br /> APPROVALS IF IF DAT[ OTHIN <br /> I ENVIRONMINIAL CHECK LISTPLNAI TY URC <br /> SIC NINA <br /> 7 6UILDING PLANS <br /> IOTAL [ <br /> S FIR[ HYDRANT <br /> A FIRE PROTECTION SYSTEM PERMIT VALIDATION <br /> WHEN PROPERLY VALIDATED FIN THIS SPACU THIS IS YOUR PERMIT <br /> S GRADITIGII XCAVAT ION&CL IAN INGIGRUBRING I <br /> ` <br /> 6 DRAINAGE �� G K�V •�;�� �� / (i�.V -i�G�-R� ! <br /> 7 INVIRONMENIAt IMPACT STATEMENT <br /> B HEALTH DISTRICT <br /> APPLICATION ACC BY PLANS CHECKED BY APPA EOR ISSUANCE BY <br /> 9.179 <br />