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the Evergreen <br />(= APPLICATION F4':2 <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT 259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />I L,r.Anl ITInM nrOMBINATION ❑BUILDING (((MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />CLASS OF WORK <br />0 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL.INSERT BUILDING RELOCATION <br />VALUATION OF WORN ICOSf OF MAIERMLS PLUSLABOM <br />DESCRIBE WORK %) e J L� � S 1•✓ <br />Il d <br />Iu cCNC ,a,, "f V- rl)/!J. <br />- IRO OT� C <br />NTT LA�TJln `�i »S I <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW TH E SAM E TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF PRoPERTYISHOWN BELOW on ATTACH FOUR COPIES; <br />LEGAL DEscnIPTJoN <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />LOT­ BLOC" OF <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X� <br />APPLICANTS CITY BUSIN 5LICENSE NO. <br />PROJECT ADBRF�^�S <br />75 4 very rt w� <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />3 <br />AIR COND. UNITS—H.P. E0. L. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS—H.P. EA <br />BATHTUB <br />BOILERS—H.P. EA <br />LAVATORY (WASH DASI NI <br />GAS FIRED AC. UNITS —TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />, <br />KITCHEN SINKS DISP. <br />M <br />DISHWASHER <br />a <br />WALL HEATERS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />EVAPORAT=CHIMNEY <br />CLOTHES WASHER <br />CLOTHES <br />WATER HEATER <br />VENTILATI_DRINKING <br />URINAL <br />FOUNTAIN <br />RANGE HOFLOOR <br />HANDL.F.M.VACUUM <br />DRAINAIR <br />BREAKERS <br />— <br />STOVEROOF <br />METAL FIREYSINK(SERVICE—BAR. <br />DRAINS—RAINLEADERS <br />WOODSTOSERT <br />ETC. <br />SUBTOTAL s <br />SUB TOTAL <br />SUB TO <br />S <br />PERMIT S <br />S <br />S <br />s <br />TOTALFEE S <br />TOTAL FEE <br />SIZE OF BLDG. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />__.___......., mne ecm¢K PLAN CHECK NUMDER PLAN CIIEGK <br />•UT ARLA VACANT SITE <br />OYES ONO <br />DCCUPANCY GROUP NO. OF DWELLING UNITS <br />NO. OF STORIES MAX OCC. LOAD <br />TED ❑ YES O NO <br />PLANS CHECKED BY APPR. FOR ISSUANCE BY <br />FEE I RECEIPT NO. <br />FEES VALUATION FEE I <br />BUILDING s <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />