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the Evergreen <br />CITY OF <br />everett <br />PPLICATION FOh JAN 17 1986 !VlTETI <br />CONSTRUCTION_................................................. e <br />PERMIT CITY OF EVERETT <br />Pt!t:ic Works Dcot. <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />❑ <br />COMBINATION <br />0 <br />BUILDING <br />❑ <br />MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />LITV <br />21P <br />PHONE <br />OWNER <br />MAIL ADDRESS <br />R 1 <br />8jyj <br />FVCRA <br />q 82 3 <br />ZPHONE �2980 <br />C <br />{Z <br />p <br />OIb <br />Q EV <br />E Rw <br />R)I <br />ARCHITECT OR DESIGNER <br />TI'ERA <br />MAIL ADURESS <br />J <br />D'TM <br />ZIPO <br />PHONE <br />A III <br />'' .. <br />rl (��' <br />L'TM <br />ZIP <br />PHONE <br />LICENSE <br />GENCRAL CONTRACTOR <br />MAIL ADURESS <br />T. !\r.l <br />As <br />A nvc <br />tIP <br />PHONE <br />LICENSE • <br />MECHANICALCAL CONiflALIOq <br />MAIL ADDRESS <br />CI1V <br />i IT 1.11 <br />A` <br />AI ISOV <br />ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />CLASS OF WORK <br />❑ REPAIR <br />1p <br />;R DEMOLITION <br />❑ WOODSTOVE/FRPLANSERT <br />❑ BUILDING RELOCATION <br />❑ NEW ❑ ADDITION <br />.®i <br />ALTERATION <br />VALIMTION Of WORY.ICOST OF MATERIALS <br />PLUS LABORI <br />AA A <br />USE Oi BNP.DIhO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PtAc bar)wivo A7fNfb!!7. PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />LEGAL OCGGbIPN01(OF PNUPCIILY ISHDWN BEIUW OR ATTACd FOUR COPIESI OFWOR�WIL�F LAWS AND ORDINANCES GOVERNING THISTYPE <br />BE OMPLE ED WITH WHETHER SPECIFIED HERE- <br />LO1-2(2-0(OCK .�Oi <br />RFVrjRLx Pagli sejj%llswIN OR NOT. THE GRANTING OF A PERMIT DOES NOTPRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />t L ¢ ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />At f VoL <br />x <br />APPLICANTS CITY BUSINESS IICE.' NO <br />PROJf(:1JDaRE^,9 601b BEVERIy �N.�•L <br />I: VE RE If WAA6�(•IGtun 192L13 <br />PLUM UIN6 <br />NO. <br />0 <br />(% <br />_U <br />— <br />^—'— __ <br />_ T.-- OF FIXTURE <br />W ATEIT f',LOSET II OILF h- <br />BATHTUB <br />LACATOF'lIWASH BAiIM <br />SHUWEH ------ <br />KITCHEN SINK A DIS_P_ _ <br />FEE <br />M[L:nwrvn.IA� <br />NO. <br />TYPE OF EQUIPMENT <br />AIR NITS-H.P. EA <br />REFRIGERATION UNITS-H. P. EA. <br />BOILERS-H P. EA. <br />FEE <br />-� <br />__ <br />_ <br />GAS FIRED AC UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS -BTU M EA <br />WALL HEATERS-B U. M <br />_ <br />— <br />,J <br />�- <br />a7 <br />,^. <br />DISHWASHER <br />�---------- <br />LAUNURVTRAV ------- <br />CLOTHES WASHFP <br />WATER HLATER <br />(INITIAL <br />DRINKING FOUNFAIN <br />_ _ <br />--- <br />— <br />-- <br />--- <br />'- <br />i <br />. <br />UNIT HEATERS-B T. U. M <br />- <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />-- <br />AIR HANDLING UNIT- C F.M, <br />--- <br />STOVE . <br />METAL FIREPLACE A CHIMNEY <br />WOODSTOVE/FIREPLACE INSERT <br />__ <br />- <br />--- <br />J _ <br />y. <br />FLOORDRAIY_ <br />\'ACWMBRF. AKERS <br />R00; ORAIIIS_RAINLEADERS <br />GIIJK SE_RVICE-BAR, ETC. <br />---- <br />SUB TOTAL <br />PERMIT f <br />TOTAL FEE f <br />f <br />SUBTOTAL f <br />PERMIT <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />