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PPLICATI <br /> the ACONSTRUOCT1Oi R eYP1en <br /> CITY OF <br /> everett PERMIT <br /> DIVE OF COMMUNITY DEVELOPMENT SERVICES <br /> CITY HALL 259-0715 <br /> EVERETT.WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br /> OWNIR MMI ADDRFSS /J UI, / ) ) ZIP�./p PHONE (� <br /> ARMltHtl'OIII D4IGNIR / /L1 JJ /IIADORlS l/L `CJ ZIP/ V PHON! <br /> CI NI RAI CONTRACTORMMI AODRISS CITY ZIP PHONE LICINSl1 <br /> Ic eJ7-A7�srld yea"l3 Y�gE o�a� <br /> MECHANICAL CONTRACTOR MAIL ADORLSS CITY T ZIP PHONE LICENSI I <br /> PIUMRIM.CONTRACTOR MAIL ADDRISS CITY ZIP PROM LICENSE IT +R <br /> CI ASS Of WORK I <br /> ❑NEW ❑ADDITION ❑ALTERATION EIRE PAIR ❑m,%1011TION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING REL-CATION <br /> %ALUATInN OE WORK <br /> S <br /> OI SI'RIBI w�Rky / K , <br /> PROPOSED USE OI RUIIDINc V It I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT A'.L <br /> HGAI DISCRIPTIONOF PROPIRTY(SHOWN MEOW CM ATTACH FOURCOPHSI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> LOT_RIOCK_OF 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 /> EOR AnoRl ss 0 ' 1 / <br /> PLUMBING MECHANICAL <br /> NO. IVPE OI FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> WATT R CLOSE T I IOLIF II AIR COND UNITS-HP FA <br /> BATHTUR REIRICIRAIION UNITS-HP !A <br /> LAVATORY(WASH BASIN) BOILERS-HP FA <br /> SHOWER GAS FIRED AC UNITS-TONNAGE EA <br /> KITCHEN SINK A DISP FORCED AIR SYSTEMS-11 T U MLA <br /> DISWASHfR WALI HE All RS-BTU M _ <br /> LAUNDRY TRAY UNIT HE ATI RS-It I U M <br /> CLOTHES WASHER IVAPORATIVE COOLERS <br /> WATER Ht AtER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- C F M <br /> VACUUM BREAKERS STOV SU <br /> ROOF DRAINS-RAINLE ADE ITS Mf TAI FIRE CE ACHIMNEY _ <br /> SINK(SERVICE-BAR.ETC) <br /> SUB TOTAL SUB TOTAL S <br /> PERMIT S PERMIT 3 U 00 <br /> TOTAL FEE IF TOTAL FEE IF <br /> SIDE YARD SETBACK STREET SETBAt K RI I-YARD SETBACK PLAN CHUCK NUMBER PLAN CHICK FEE <br /> FIE RECEIPT NO. <br /> USE ZONE 101 AREA VACANT SITE <br /> EYES ONO F/[S VALUATION HL <br /> TYPE OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS <br /> BUILDING S <br /> SIZE OF BLDG NO OF STORIES MAX OCC LOAD <br /> PLUMBING <br /> FIRE ZONE BASEMENT BE DRE(IMS "Ill SPRINKLERS <br /> REQUIRED MECHANICAL <br /> "YES FINO <br /> �.i <br /> APPROVALS SY DATE OTHER <br /> 1 ENVIRONMENTAL CHECK LIST FINALES UBC <br /> SIC )0X11 <br /> 2 BUILDING PLANS <br /> I FIRE HYDRANT TOTAL <br /> A FIRE PROIFCIION SYSTEM PERMIT VALIDATION <br /> WHIN PROPERLY VALIDATED UN THIS SPACEI THIS IS YOUR PERMIT <br /> LS GRADING(XCAVAI ION B CLI ARINGlGRUBBING <br /> b DRAINAGE <br /> 7 ENVIRONMENTAL IMPACT STATEMENT <br /> S HEALTH DISIRICT <br /> APPLICATION ACC BY PLANS CHECKED In APPR FOR ISSUANCE BY <br /> 941.79 <br />