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m <br />I <br />IABEwrgwn APPLICATION FOR ieyeTell <br />cm Of %.CONSTRUCTION e <br />everett PERMIT <br />DEPT OF COMMUNIT . DEVELOPMENT SERVICES <br />CITY HAL_ 259-04S <br />EVERLTT. WA9e201 ❑COMBINATION ElBUILDING ❑MECHAN►CAL ❑PLUMBING PERMIT NO. <br />OWNIR MAII AUIIRISS (IT, LIP PHONI <br />A0.(11�111R I410l0. MAII AUUPIS III\ ZIP PNONI <br />CANIRU CONIA4:IOR MAIL ADDRISS CITY ZIP PHONI LICINSFI <br />Aca �e <br />NI(HAYICM (11Y1PAClllq MAIL ADD0.f SS CITY LIP N10N1 IICINSII <br />PIUMBP.6 CONIRA001 AIAI(AODRISS (111 ZIP PHONE LICENSE. <br />(1ASS OF WORK <br />$NEW ❑ADDITION UALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VS.UAIIOb OF WORK ^D <br />A. ¢7, EJ6U• <br />DISCRIBI WOR 1 _— <br />PR0.01,10 usl Up BUIIDI`S <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGUI.\TING CONSTRUCTION <br />OR T ORMANCE OF CONSTRUCTION. <br />SIG U 1 NTRACTOR OR AUTHORIZ[D AC:NT DATE <br />x <br />u r.M Dl scglP oN UI PgoPegn IMaswN Anew Uq An.ul n.uR coPll s, <br />/ <br />1°1KIL':K—UI <br />�.f <br />,.Y /�-'S1 ` <br />R i YS_ J <br />CC// <br />FOR AUDRI SS <br />`2 G <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />IL <br />\VATSR CLOSI 111011/71 <br />AIR COND UNITS—H P FA <br />BATHTUB <br />2170 <br />RIFRIGfRA110NUNITS-HP IA <br />LAVATORY (WASH BASIN) <br />BOIL[R$ - IF P FA <br />SHOWER <br />GAS HRFD AC UNITS-TONNAGI IA <br />IT <br />K17CHIN SINK A [LISP <br />FORCED AIR SYSTIMS-B T U M lA <br />DISWASHER <br />040 <br />W'ALI HIATIBS-B I M <br />LAUNDRYIRAY <br />UNIT IHATFRS-BTU M <br />CI OTHI S WASNF R <br />00 <br />I VAPORATIVI COOLERS <br />WATER HIATIA <br />0/ <br />CIOTIIfs DRYIRS <br />URINAL <br />VINOIATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CFM <br />VACUUM FIRE AKE ITS <br />STOVE <br />ROOF DRAINS -RAINY AOI ITS <br />MI IAL FIREPLACE A CHIMNEY <br />SINK ISFRVICI-BAR, ETC 1 <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />( <br />TOTALFFE S <br />SIOf YARD St TRACK <br />L <br />STRFFTSIIRACK <br />A <br />oiO <br />RIARYAROSITBACK <br />ca�0 <br />PLAN CHICK NUMBIR <br />7 qC/ <br />�oF� / T <br />PLAN <br />Ft[ <br />CHECK EEL <br />RECEIPT NO <br />D$f ZOto <br />JOT ARIA <br />V 'ANT 511E <br />}�LS CNO <br />HIS <br />VALUATION <br />FEE <br />TYPI OF CONIS1) <br />V_N <br />OCCUPANCY GROUP <br />P-3 <br />NO OF OWIIL NG UNITS <br />/ <br />BUILDING <br />q� <br />S4.'! 40 AC <br />-I �'CL <br />/LL <br />SIZI OF BLDG <br />11) / & <br />NO OF STORIES <br />I <br />MAX OCC LOAD <br />NUMBING <br />FIRE ZONE <br />BASEMENT <br />III[LR(B)MS <br />IIRI SPRINKLERS <br />REQUIRlD <br />MISFIND <br />MICHANIL'AI <br />AAROVASS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTALCHt CK LIST <br />PENALTY <br />UPC <br />SEC SOAR) <br />7 BUILDING PLANS <br />TOTAL <br />I FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />S GRADINCII XCAVAT ION A CUT AITINGICRUBBING <br />PERMIT VALIDATION <br />T <br />WHEN PROPERLY VALIDATED TIN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />`'U <br />PLANS CHECKED BY <br />S?`Y <br />APPR FOR ISSUANCE BY <br />G • 6. <br />9�1 Jv <br />