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AL PLICATION FOR YPTPH <br />everett DNPERMITTIUN <br />DLPT. OI COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT.WA98201 []COMBINATION El BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />H Q 81fe rr 16117-BUtl2 M Evert!/ _ qw 3 11 9ai,/ <br />OR OE SIGNIR MAIL AOORI SS CITY lip PIIONE <br />GINIRAL CONTRACTOR MAIL ADDRI SS CITY !IP PHONE LICINSII <br />CONTRACTOR MAIL <br />PLUMBINGCONTRACIOR MAIL ADDIRSS CITY 21P PIIONF LICENSIIF <br />CLASS Of WORK <br />❑NEW ❑ADDITION IKA.IERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK <br />E 37NIV, Q4 <br />DESCRIBE W�A OR <br />AA/AJ. AI <br />Diu i I� <br />PROPOSED UST 01 BUILDING <br />LfGAR DISCRIPTION OF PRONRTY(SHOWN BELOWOR MIAtll FOUR COPIES) <br />Lot _HIOCX_01 <br />I 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 CANCEI THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PE FORMANCE F CONSTRUCTION. <br />SIGNATURE CONTRACTOR UTHORIZED AGENT DATE <br />X <br />109 AADORI SS <br />PLUMBING <br />MECH NI AL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATT R CLOSET(TOLIEO <br />AIR COND UNITS —HP IA <br />BATHTUB <br />REFRIGERATION UNITS —HP IA <br />I AVATORY (WASH BASIN) <br />BOILERS—H P fA <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE [A <br />KITCHIN SINK A DISP <br />FORCID AIR SYSTEMS—B T.U. M EA <br />OISWASHFR <br />WALL HEATERS—B.TU N <br />LAUNDRY TRAY <br />UNIT 14EATERS—B.1 U M <br />CIOTIBS WASHER <br />EVAPORATIVE COOLERS <br />WATIR HEATER <br />CLOT14FS DRYERS <br />URINAL <br />VENTRAtIJN FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M <br />VACUUM BREAKERS <br />STOVE <br />ROOK DRAINS—RAINI FADE ITS <br />METAL FIRFPLACF A CHIMNEY <br />SINK (SERVICE —BAR, TIC ) <br />STIFF TOTAL <br />SUB TOTAL s <br />PERMIT <br />s <br />PERMIT s <br />TOTAL FEE <br />s <br />I <br />TOTAL FEE s <br />SIDE YARD SETBACK <br />SIR[ IT SI IBACK <br />U AR) ARU V 11; el K <br />PLAN CHECK NUMBER <br />PLAN <br />III <br />CHECK FEE <br />RECEIPT'40. <br />USE ZONE <br />LOT AREA <br />L M ANT SITE <br />,IS ONCEF[FS <br />VALUATION <br />THE <br />TYPE OF CLNST. <br />OCCUPANCY GROUP <br />Ni 1 Ill DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG. <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />HI ORO(1MS <br />FIRE SPRINKI IRS <br />RE QUIRI0 <br />NIS NO <br />MECHANICAL <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />I ENVIRONMENTAL CHECK LIST <br />PENALTY' <br />UBC <br />SIC )ORII <br />2 BUILDING PLANS <br />TOTAL <br />E FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />5 GRADING(E XCAVA KION A C LI ARINGIGRUIIHING <br />PERMIT VALIDATION <br />WHIN PROPERLY VALIDATED(IN THIS SPACE) THIS IS YOUR PERMIT <br />6 DRAINAGE <br />