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APPLICATION FOR <br />CONSTRUCTION ��b tYBFlR <br />the Ev.rgr en <br />CITY OF <br />evellett PERMIT wl�sol� e <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />259-8810 <br />.. . <br />❑ DEMOLITION <br />O COMBINATION Y BUILDING <br />❑ MECHANICAL <br />❑ PLUMBING ', O SIGN, <br />OWOEB MAILADDRESS <br />'=VIEILETf- PMF651D1.1A,1.. PnDPt'LZTlES CIO��(KE�-+A�.1 <br />City ZIP P14ONE i. 1 <br />AiLL1AiTgCTS �cu�c.c ot��nt <br />ARCMIIEC1 OO Ok51UNEP <br />MML MDNE S$ <br />ItoI t+6wLT{' AA16 <br />CITY ZIP <br />1= vs(tEt7" WA `l0-u�l <br />PHONE <br />ZS9-31(Ol <br />.tµr p�y�MAT.I <br />ARL►1ST i5 <br />_.._.... _,....... �..... <br />MAIL ADDIIE55 <br />CIIY LP <br />PPONE LICENSE. <br />Nk CNANICAL COMIRACIDR MAIL ADOnE55 CITY ZIP -- PHONE LICENSE <br />. I ON MAIL ADDRESS GI1V ZIP POONE LICENSE <br />PIUMBINR CONTRA( • <br />CLAESOI WVI.e <br />❑ NEW ❑ ADDITION K ALTERAIICN ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOV'C/FRPL.INSERT BUILDING RELOCATION <br />_- *1pPoo <br />UF3CRI9E WMMK I u30 S.F• <br />IVY^11 _ <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />OiFtCEF <br />_ <br />PLICATIONAND KNOW THESAME TOBETRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTYISNOWN BELOW OR At IACH FOUR COPIES) <br />11-z7 82A pLJcT aF� <br />OF WORK WILL BE COMPLETED WITH WHETHER3PECIFIF.DHERE- <br />LOI_BLOCK_—or <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 <br />GIVE AU7HOR11Y TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONIRAGIOR OR AUTHORIZED AGENT DATE <br />X <br />PROJECT ADDRESS <br />-L'►-1.2 co�lsy <br />A•vE • <br />APPLICANrS CITY PUSINESS LICENSE NO <br />rr <br />C lc #f(° <br />�l� <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENi <br />FEE <br />WATER CLOSET ITO-LET) <br />A/C — AMNDLG UNITS — HD. <br />REFRIGERATION UNITS — H.P. EA, <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS—BT.U.MI . <br />GAS FIRED A.C. UNIT:B. '—TtI <br />SHOWER. <br />—1 <br />FORCED AIR SYSTEW!, — B.T.U. M EA <br />KITCHEN SINK l UISP <br />WALL HEATERS—B.T.I. M <br />DISHWASHER <br />UNIT HEATERS—B.T.U. M <br />UUNORY TRAY <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />CLOTHESDRYERS <br />URINAL <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />SACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEAUERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC I <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />_ <br />EXHAUST FAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTAL FEE <br />S <br />_ TOTAL <br />- <br />PLAN CHECK NUMBER <br />SIDE SETBACK <br />I wUI)t SEIOACK FEAR SETBACK <br />LOT AREA <br />VACA14T SITE <br />FEES <br />FEE <br />®rEERECEIPTNO.T7aUSEZUNE <br />1 <br />OYES DNO1 <br />BUILDING <br />/ <br />hPE Or WNSt OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG NR Or STORIES <br />MAX OCC LOAD <br />MECHAWCAL <br />ISJ li�l4 <br />15� <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES p NF. O <br />_ <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPUDAIIUNACC BY <br />PLANS CHECKEED`D By <br />AI'Pn FOR ISSUANCE By <br />UBLICWORKS <br />[TOTAL <br />lYl`J <br />PROPERTY OL1. _ __ <br />PROPERTY LINEINE LOO CATA7IONS AND RELATED EASEMENTS. <br />