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the Evergreen APPLICATION FOR everett <br /> CITY OF CONSTRUCTION <br /> everett <br /> PERMIT • , <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. • <br /> 259-8745 ❑ COMBINATION ,® BUILDING ❑ MECHANICAL 0 PLUMBING 0 SIGN <br /> OWNER MAIL ADDRESS CITY ZIP PHONE <br /> I) Pi )I6 rh c c- TY)C, Fri to Sb, Tcomu Uu y �=tcroma c/ 9C j 58'y- ,22 4'(79 <br /> ARCHITECT OR DESIGNER MAIL ADDRESS 7 CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP - PHONE LICENSE* <br /> \ 'St is 4 ConsZruc io y) 9/4 Sv,jaca rxc kiy l coma 'NV?? ,s-e9-OSOo t4at I/oVC <br /> MECHANICAL CONTRACTOR - MAIL ADDRESS - CITY ZIP PHONE LICENSE$ <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE - LICENSE it <br /> CLASS OF WORK <br /> 0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR ❑ DEMOLITION 0 WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VALUATION OF WORK(COST OF MATERIALS PLUS LABOR) <br /> ,i 3 4/) S ao !979 I,a racer ,yx 60 ) cer i01.)4* 01028 <br /> DESCRIBE WORK /vf 1 <br /> COY/Crete ?/_)a) o // l7` 7D cii Y / /vr1,ie Nomt usei cts UiCce <br /> USE OF BUILDING <br /> �Y J/ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> c +.-( c.e Sa/tS C.,e4tp Jr PLICATION AND KNOWTHE SAME TO BE TRUEAND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> if- //JJ �' ) y- OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> LOT >+W BLOCK �' 'OF of'iki r..C:, y I fl IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> 1�'11 c // Co, / GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br /> 111✓)S!'O rl IUD, 1 .3/�t7hle,,, J C 1dt AiNy'n,ap r ANY OR THE ER STATE <br /> OR LOCAL <br /> E OF CONSTRUCTION. <br /> CONSTRUCTION <br /> 9�) IGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE Dec,plat Y�cor�e� t» V,a�r�Niwl� 1/ �y�'p��s ,o�'pap 9 <br /> keGor'�S �noAo,ei11s) C�.runZ X <br /> PROJECT ADDRESS . -APPLICR TS CITY BUSINESS LICENSE NO. <br /> 'Iliat. <br /> - <br /> 7/ veryYee Way <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> L2 WATER CLOSET(TOILET) AIR COND. UNITS—H.P.EA. <br /> BATHTUB REFRIGERATION UNITS—H.P. EA. <br /> c LAVATORY(WASH BASIN) BOILERS—H.P.EA. <br /> SHOWER GAS FIRED A.C. UNITS—TONNAGE EA <br /> l KITCHEN SINK&DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> / DISHWASHER WALL HEATERS—B.T.U. M <br /> LAUNDRY TRAY UNIT HEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE — _ <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACE&CHIMNEY <br /> SINK(SERVICE—BAR, ETC) WOODSTOVE/FIREPLACE INSERT <br /> SUB TOTAL SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> f�'� t� .;.� I FEE y. � REC,PT NOo <br /> USE ZONE LOT AREA VACANT SITE <br /> OYES ONO FEES VALUATION FEE' <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> BUILDING $ <br /> SIZE OF BLDG. NO.OF STORIES MAX.OCC.LOAD <br /> PLUMBING <br /> MECHANICAL <br /> FIRE SPRINKLERS REQUIRED 0 YES 0 NO <br /> OTHER <br /> PENALTY <br /> APPLICATION ACC.BY PLANS CHECKED BY APPR.FOR ISSUANCE BY . <br /> TOTAL <br />