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APPLICATION FOR tY) <br />Cl" "'" <br />the TY CONSTRUCTION 0 <br />COF <br />everett PERMIT <br />DFPT OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 759-8745 <br />EVERETT. WA9BZDt ❑COMBINATION El BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />MAR AUURH] if <br />' n tlp vunm <br />OWNI <br />!J.) 76%2-lm- ]-c/L.f <br />Otv lip <br />IRON[ IICFNIf I <br />GINIRAI CONTRACTOR <br />MAIL ADDRESS <br />CITY [I/ <br />PHONE LICENSE I <br />MECHANICAL ~11ACTOR <br />MAIL ADDRESS <br />CITY LIP <br />IHONI IIClNWE <br />PIUMRING CONTRACTOR <br />MAIL ADDRI )) <br />CLASS W WORK <br />❑ALTERATION ❑RI PAIR <br />KOEMOLITION ❑ff NCF. ❑SIGN <br />❑GARAGE DBUILDING RELOCATION <br />❑NEW ❑ADDITION <br />I VAIUAIIONOI WORK <br />_ <br />S <br />WORK <br />USE of ROIIDINC <br />IIGAt DESCRIPTION Of IROIIRTY (SHOWN PI tOW OR ATTACH SOUR COPES) <br />IOF— Bloc* —Of - <br />TOP ADORIM <br />HI�2U <br />PLUMBING <br />un TYPE Of <br />K IICHIN SIR <br />DISW ASHE R <br />I AUNORY 11 <br />1'101 MI5 W <br />AOI <br />(I <br />TOTAL <br />S <br />Fit <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT THE <br />A PERMIT <br />S NOT PRESUME TO <br />GIVE AUTHORITY ATOIFE <br />VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />)ICNATURE Of CONTRF.CTOR ON AUTHORIZED AGENT DATE <br />TYPE Of EQUIPMENT t FEE <br />AIR C )NO UNITS -HP !A <br />RFIRICF RATION UNITS-NP EA <br />ROMRS-HP EA <br />GAS IIRlD AC UNITS -TONNAGE EA <br />1 ORL FD AIR SYSTEMS-B 1 U M EA <br />WAIT HIAIIRS-BIU M _ <br />UN'E HIATFRS-BTU M <br />IV LPORATIVF COOLERS <br />CLOTHES DRYERS <br />V,NIILATION FAN <br />RANG! HOOD _ <br />AIR HANDLING UNIT- C F M <br />STOVE <br />METAL FIREPLACE 6 CHIMNEY __ <br />TOTAL IFI <br />STD! YARD W THA(K STRRI St ;A( K RI AR ]ARO St IBA('K PLAN C/TICK NUMflFR <br />TYPE <br />AP►ROVALS <br />1 ENVIRONMENTAL CHECK LIST <br />t BUILOING PLANS <br />S FIRE HYDRANI <br />I FIRE PROTECTION SYSTEM <br />S GRADINGIIKCAVAIIONLCLLARINGIGAUBRING <br />6 DRAINAGE <br />T ENVIRONMENTAL IMPACT STATEMENT <br />6 HEALTH DISTRICT <br />VACANT SITE <br />DYES ❑NO <br />TOTAL <br />S _ <br />MIT <br />S <br />'Al Fit <br />S <br />IAN I III' A III <br />III <br />I <br />RICE IPI NO <br />VARIATION I FFF <br />BUILDING <br />AR OCC LOAD <br />PLUMBING <br />--- <br />IRE SPRINKLERS <br />EQUIRED <br />MECHANICAL <br />'YES FIND <br />BY DATE <br />OTHER <br />II' <br />PENALTY <br />5LC RIRaI <br />TOTAL <br />PERMIT VALIDATION <br />THIS SPACE) THIS IS YOUR PERMIT <br />WMFN PROPERLY VALIDATED (IN <br />CHECKED HY I APPR II IR I]SUANI I H] <br />941-79 <br />