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the Evergreen `APPLICATION FW CY(1TBR <br />CITY OF CONSTRUCTION .� <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OW En MAR ADOR E55 CITY ZIP PHONE <br />AnrHITEGi(�551.'aNER MAIL ADDRESS <br />ZIP PHONE <br />Jt <br />GENERAL COH AATCRCY� MAIL ADDRESS CIw ZIP PHONE LICENSE• <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAILADORESS CITY ZIP PHONE LICENSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR <br />MLUATION OF WORK (COST OF MATE RMLS PLUS LABOR) <br />DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />USE OF BUILD I NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT, ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OFWORKWILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />IOR THE -PER fi ANCE OF CONSTRUCTION. <br />S�GNA URE F C {OR� AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW ORATTACH FOURCOPIES) <br />/ -MP0 7 u.^�LISI VIE� Lti< <br />', '' <br />' 1 1' <br />:7� ftA'r ar L-vLt=�r.Ovi I!OiJG AS FLI—' <br />�� R���l � lu YOL �� �-; pu�-� CA] <br />1-:! <br />' �-r�tE et7 <br />PROJECT ADDRESS /� <br />Z` 11 CT1505PL77 <br />APPL ANTS CITY BU NESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA, <br />LAVAIORY(WASH BP 3114) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCF EN SINK 6 DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />DISHWASHER <br />_ <br />WALL HEATERS—B.T.U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTIIES WASHER <br />I EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAK[. IRS <br />STOVE <br />ROOF DRAINS—SAINLEADERS <br />METAL FIREPLACE &METAL FIREPLACE CHIMNEY <br />SINK SERVICE —BAH ETC._ <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUBTOTAL f <br />_ <br />_ <br />PERMIT sl <br />PERMIT f <br />TOTAL FEE 3 <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />-- TVA <br />RECEIPT NO. <br />LOT AREA VACANT SITr: <br />FEESLUATION FEE <br />OYES ONO <br />TYPE OF CONST, <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PSNALTY <br />APPLICATION ACC. BY <br />G <br />PLANSCHECKED BY <br />I <br />GPPR. FOR ISSUANCE BY <br />TOTAL <br />— <br />aco I o b <br />