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the Evergreen I1PPLICATION FO', everetl <br />CITY OF CONSTRUCTION <br />everett PERMIT E' <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING $I MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNED MAIL ADDRESS <br />CITY ZIP PHONE <br />LrlroL-7 PraK-rQprY s al5 SL, EV E11 r•RLL �Y cv �cH uA G344S4_ <br />� <br />ARCHITECT OR DESIGNER MAIL ADDRESS Clry ZIP PNONE <br />G—A✓L�r CA It, ki5C cw <br />GENERAL ON FACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEr <br />O u f leg, <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEr <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR, <br />DESCRIBE WORK <br />INsrALL P n9l�G� <br />USE OF BUILDING <br />cj`H1L E'I} cL� SALT-s <br />D -�l/I i-6 Ski <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL 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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAT CONSR C OR OR 11 RIZED AGENT DATE <br />l L— 2 3 -_ 2 7 <br />LUAL DESCRIPTION OF PROPERTYISHOWN BELOWOR ATTACH FOUR COPIES, <br />Lol_BLocI�—oF <br />PROJECTADDRESS <br />at5 SLS Cve EFt- ;� PL-I_ <br />C <br />L�aY <br />APPLICANTSCITY BUSIN S LICENS N <br />V> 4 O t-- I c, D k L 2-0 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS — H.P <br />BATHTUB <br />REFRIGERATION UNITS — N.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T. U.M.P. <br />SHOWER <br />GAS FIRED A.C. UNITS —B.T.U. <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS — B.T,U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC.) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />SXHAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTALFEE <br />f <br />TOTAL FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF SLOG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICA110N ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />