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PPLICATIONIFON� <br />eYeFrN <br />Evergreen <br />theCITY <br />CONSTRUCT <br />CITY OF <br />.1 <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />259-8745 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />WIER <br />MAIL ADDRESS CITY ZIP <br />-'n, -- <br />PHONE <br />0 -3 7' <br />- <br />Fa r a <br />PHONE <br />ABCHITECI OR DESIGN <br />CITY <br />MAIL ADDRESS 21P <br />'ENEFML CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />l t ��••r iP�rx <br />PHONE LICENSE• <br />� �l,s� i?a.uve <br />/�` <br />IRF uva�� %EA < <br />�7/i !<oa��,�v �111 12e <br />Z P <br />PRUNE LICENSE <br />PLUMBING COHf RACTOi MAIL PODRESS CIIY ZIP PHONE LICENSE <br />• <br />:LASS Of WORK ,..,/ <br />Cl NEW C ADDITION NJ ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPL.INSERT Cl BUILDING RELOCATION <br />JALUATION OF WORN ICOLiT Of MA.E VIALS PLUS LABORI <br />I _ L — <br />Iw <br />USE OF BUILDING <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 />PROVISIONSOFLAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF PROPERTY ISNOWN BELOW OR ATTACH FOUR COPIES) <br />LEGAL DESCRIPTION <br />OF WORK WILL BE COMPLETEC WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT_SLOCK- OF <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. Q <br />SIGNATJRE CONTRACTOR OR AUTHOFUZED AGENT DATE <br />X <br />C <br />AO (CANT BU SSLILEHSE NO <br />PROJECT ADDRESS <br />7/ S� 7/h(IN.<,fc <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />AIR COND. UNITS—H.P. EA. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS—H.P. EA. <br />BATHTUB <br />BOILERS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />GAS FIRED AC. UNITS —TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS—B.T.U. M EA . <br />KITCHEN SINK d DISP. <br />. M __DISHWASHER <br />WAIL HEATEMLER <br />UNIT HEATEMLAUNDRYTRAVCLOTHES <br />WASHEREVAPORATIVSWATER <br />CLOTHES DRVENTILATIOURINAL <br />HEATER <br />RANGE HOO— <br />DRINKING FOUNTAIN <br />AIR HANDLIC.F.M. <br />_FLOOR <br />DRAIN <br />VACUUM BREAKER <br />STUVEROOF <br />METAL FIREHIMNEYSINK(SERVICE—BAR.ETC. <br />DRAINS—RANLEADERS <br />WOODSTOVCE INSERT <br />_ <br />SUBTOTAL f <br />SUB TOTAL <br />PERMIT t <br />PERMIT f <br />TOTALFEE f <br />TOTALFEE 3 <br />THIS PORTION TO BE COMPLETED <br />FONT SETBACKTAEARACK SIDE SETBACK <br />BY BUILDING DEPT. PERSONNEL <br />PLAN CHECK ry1UM9ER PLAN CHECK FEE <br />1 1' I`(.+ 1�I`FEE 2 RECEIPt NO15C <br />ZONE <br />0-❑YES <br />VACANT SITE <br />ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONSICY <br />GROUP <br />z <br />NO. OF DWELLING UNITS('-�- <br />'� <br />BUILDINGWE <br />OF BWGORIES MAX OCC. LOAD <br />2 Z Z <br />FIRE SPRINKLERS REOUIRED DYES ❑ NO <br />PLUMBING <br />PAEC14ANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC BY <br />PLANSCIIECKED BY <br />/� <br />APPR. FOR ISSUANCE BY <br />L • C� <br />TOTAL <br />i <br />_ <br />Piar2Ciuq .dAZpl <br />51J?tFo # :Ad�voxeo PEA <br />IV .M.G 191-40, oic��f3) <br />r <br />