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I <br />`PPLICATION FO►�' <br />the Evergreen <br />clrr of <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />ARCM I CT OR <br />I n7 Cr. <br />IVkCD , �,VI 9d9y <br />MAIL ADDRESS <br />MAIL ADOnESS <br />_/l-:5SC,C/A-7 e3 _ / <br />MAIL ADDRESS <br />ove <br />CITY <br />/9x o <br />CITY <br />O'PLUMBING <br />PHONE <br />PHONE <br />PUBNc <br />PHONE <br />❑ SIGN <br />LICENSE <br />LICENSE <br />' I�I lY ZIP PHONE �w PT/ v <br />€� N So rl ffie E�7`J'N l r,4 L 1-6 931 rn elta F Pa 99-22 3 652 >({7,/ <br />CLASS OF WORK _ <br />❑ NEW ❑ ADDITIOIN ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORKICOST OF MATERIALS PLUS LABOR) <br />Be CRIBE WORK <br />USE OF BUILDING <br />,,, ,. <br />r/1d! 4A r <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PE WAIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />S IO NATURE pp CONTRACTO10 AUTHORIZEOAGENT DATE <br />X <br />LEG41L DESCRIPTIONO PF OPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LCH__BLOCK—OF <br />i <br />PROJECT ADDRESS <br />Teo( <br />APPLICAN iS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER Cl OSET (TOILET) <br />A/C —A/HNDLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — 14 P. EA. <br />LAVATORY ( WASH BASIN) <br />BOILERS — B.T.0 IH. P. <br />SHOWER <br />GAS FIRED A.C. UNITS — O.T.U. <br />KITCHEN SINK d CISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />OISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />Lim r HEATERS—B.T.U. M <br />CLOTHES WASHER <br />I <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHESORYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — HAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE —BAR. ETC) <br />METAL FIREPLACE & CHUANEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL f <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE f <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO, <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDINGO <br />S <br />TIPE OF CONSi. <br />OCCUPANCY GROUP <br />NOF DWELLING UNITS <br />PLUMBINP <br />_ <br />-N <br />SIZE OF BLDG <br />NO OF STORKS <br />MAX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REOUIRED ❑ YES D NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. BY PLANS CHECKED BY APPR FOIL ISSUANCE BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />-- <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />