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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPT. <br />259-8745 <br />APPLICATION FO.t' <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />MAIL ADDRESS CITY ZIP PHONE <br />;z I I QD n d _ <br />MAIL ADDRESS CITY ZIP PHONE <br />❑ SIGN <br />CLASS Or WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATON OF WORK (OOST OF MATERIALS PW S --OR) <br />DESCRIBE <br />usE or BUILDING , <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />Le,15e l', SVj T IL_ <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />(SHOW( BELOWOR ATTACH FOUR COPIES) <br />LEGAL DESCRIPTION OF PROPERTY <br />WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />OF WORK <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT_BLOCK —OF. <br />TO VIOLATE OR CANCEL THEOF <br />GIVE <br />ANYOTH ROTY STIATE OR LOCAL LAW REGULATING CONSTROUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AU THO IZED AGENT DATE <br />X 0 1.2.27-9�s <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />PROJECT ADDRESS <br />bend S� <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />AIR COND. UNITS—li. P. EA. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS—H.P. EA <br />_ <br />BATHTUB <br />BOILERS—H.P. EA. <br />_ <br />LAVATORY (WASH BASIN) <br />GAS FIRED AC UNITS —TONNAGE EA 20 -t 16 <br />SHOWER _ <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />KITCHEN SINK& DISP.. <br />WALL HEATERS—B.T.U. M <br />_ <br />DISHWASHER <br />UNIT HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />— <br />ER <br />__ <br />_ <br />VENTILATION FAN <br />— <br />— <br />RANGE HOOD <br />OUNTAIN <br />AIR HANDLING UNIT— C.F.M. <br />IN <br />WSERVICE—BAR, <br />— <br />STOVE <br />--- <br />EAK[RS _ — <br />_ <br />___. <br />METAL FIREPLACE 8 CHIMNEY <br />S—RAINLEAUEHS <br />WOODSTOVE/FIREPLACE INSERT <br />CE—BAR, ETC. <br />— SUBTOTAL <br />SUBTOTAL & <br />U <br />— S <br />_ PERMIT_ <br />— <br />PERM:T S <br />TO- AL FEE It <br />— <br />Q <br />TOTALFEE $ <br />SIZE <br />THIS PORTION TO <br />BE COMPLETED <br />BV BUILDING <br />DEPT. PERSUNINtL <br />CHECK FEE <br />REAR SETBACK <br />SIDE SETBACK <br />RECEIPT NO. <br />TEE <br />FPLANNUMBERPUN <br />VALUATION <br />F[ <br />LOTARG <br />VACANT SITEFEES <br />OYES ONO <br />-- <br />1 <br />OCCUPANCY GROUP I <br />NU.Ur uo'ewnu woa <br />BUILDING S <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />--- <br />PLUMBING <br />TED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />._NALTY <br />PLA14SC14ECKED BY <br />APPR fOD ISSUANCE GY <br />TOTAL <br />