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APPLICATION FOR n <br />the pmn <br />CITY OF�:ONSTRUCTION <br />CITY or <br />everett PERMIT <br />DEPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 7594745 <br />EVERETT, WA9B201 ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />[NON! <br />OWN[R MAIL ADDRISS 1' CITY LIP <br />PLLIMRINC CONTRACTOR MAIL ADDRISS CITY ZIP PHONE LICE NSL P <br />LIASI Of ❑NEWwoRR❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />NAWAIION Or WORK <br />micl ON <br />PROPaSI sr of Bull c I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PO <br />AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />ucA1 BIScelrnnN or noNRlrlseowN [IOW OR AITACNfOURCOIIEA. PROVISIONS OF LAWS AND ORDINANCES GOVERNING PHIS TYPE <br />S OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />Los �BLocK�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 />JOB ADDRISS .— Y II /L <br />�L �v <br />A „ - <br />/ <br />%/1Py <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OF EQUIPMENT FEE <br />NO. OF FIXTURE <br />FEE <br />AIR COND UNITS —HP FA <br />WATER CLOSETIjDIIl iI <br />BEER FRATIONUNITS—HP [AflATHiUB <br />f1011[RS-LIP FA <br />I AVATORY (WASH BASIN) <br />GAS FIRED AC UNITS -TONNAGE EA <br />SHOWIR <br />FORCID SYSTEMS-R1U MFA <br />KITAIR <br />CHEN SINK A DI iP <br />WAIL l AiERS-BTU M <br />LH WAI <br />DISWASHFR <br />UNIT HF AIFRS-fl1U M <br />LAUNDRY TRAY <br />1 VAPORAiIVI COOLERS <br />i IOTHfS WASHER <br />LIOTHIS DRYERS <br />WAIIR MI AIER <br />VI NIIlAll01T FAN <br />URINAL <br />RAND[ HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING Ullli- C f M <br />11 ()0R GRAIN <br />STOVE <br />c A('UUM BRIAKIRS <br />METAL FIREPLACE 6 CHIMNEY <br />ROOF GRAINS-RAINLIADIRS <br />NNK ISFRVICf -RAR, ETC) <br />SUB TOTAL B <br />SL'B TOTAL <br />PERMIT B <br />- <br />PERMIT E <br />TOTAL FIT B <br />Z <br />TOTALEFE E <br />PLAN CHECK NUMHIR PLAN CHECK FEF <br />IF RECEIPT NO <br />SIDE YARD !ITflACK <br />VRI II SETBACK <br />RI AR YARD SI [BACK <br />USE ZONE <br />LOT ARIA <br />VACANT SITE <br />FEES <br />VALUATION <br />Fit <br />CITES ONO <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />BUILDING <br />SIZE O` BLDG NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE BASEMENT BEDROOMS <br />FIRESPRINKLERS <br />MECHANICAL <br />172 <br />YFS ❑NO <br />APPROVALS <br />BY DATE <br />OTHER <br />I ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U s tOXR) <br />SEC <br />? <br />TOTAL ) <br />Z BUILDING PLANS <br />I TIRE HYDRANT <br />A FIRE PROTECTION SYSIfM <br />PERMIT WHHEN PROPS ATION <br />VALIDAY VALIDATED TIN THIS SPACE[ THIS IS YOUR PERMIT <br />S GRADINGIIXCAVATION&CLIARINGIGRUBBING <br />6 DRAINAGE <br />7 [NVIRONMENIAE IMPACT SIAIEMENT <br />B HEALTH DISTRICT <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9.1-79 <br />