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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPT. <br />259.8745 <br />APPLICATION FOr <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />w <br />-1 <br />OWNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONF. <br />F-IMIuT-e,g mBP"K <br />`e' �! <br />-T502. E�R�N vYA/ <br />1-f1ERET[' <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />ZIP <br />PIIONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />CITY I ZIP PHONE <br />FLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />0 NEW ❑ ADDITION CI ALTERATION El REPAIR El DEMOLITION ❑ WOODSTOVE/FRPLANSERT El BUILDING RELOCATION <br />VALUATION OF WC I IK (COST OF MATERIALS FLUB LABOR) <br />0�r o�> _ <br />DESCRIBE WORK <br />QI —i LJi Co-1 t%H1AT57 Cp.ZnO2lL.TY <br />KS :.c CIF=pc[-- su <br />- - - - -- <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BETRUEAND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILL BE COMPLETED W.TH WHETHER SPECIFIED HERE- <br />LOT— BLOCK 0 <br />IN 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 />SIGNATURC OF CONTRACTOR OR AUTHOR173 AGENT CATE <br />X� Co/r3L <br />/ S <br />PROJECT ADDRESS <br />APPLICANTS citf BUSINESS LICENSE NO. <br />r16o2 <br />31+11 <br />PLUMBING <br />MECHANICAL. _ <br />NO. I TYPE OF EQUIPMENT FEE _- <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />WATER CLOSET(TOILE <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY WASH BASIN( <br />BOILERS-H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHFN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T,U. M EA. <br />DISHWASHLII <br />WALL HEAILHS--0J.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—E.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLBJG UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE —BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL 5 <br />PERMIT 6 <br />PERMIT 5 <br />TOTAL FEE 5 <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />N x <br />v <br />m <br />m J <br />n <br />-1 c <br />O 3 <br />�z <br />x i <br />m <br />.o z <br />c <br />rx <br />.... <br />---1 N <br />T <br />O 3 <br />=m <br />mN <br />or <br />n ITT <br />C LA <br />3 N <br />2 n <br />�m <br />a <br />--I <br />2 <br />a <br />2 <br />--I <br />x <br />rr <br />N <br />