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the Evergreen <br />CITY OF <br />everTett <br />259-8745 <br />❑ DEMOLITION <br />r-ONSTRUCTION � PERMIT PERMIT NO. 17898 <br />❑ COMBINATION <br />❑ BUILDING ❑ MECHANICAL N PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ur r..va <br />Tom Peeples 9609 Evergreen Way 98203 568-1263 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE+ <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEM <br />Owner <br />CLASS OF WORK <br />50 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />DESCRIBE WORK <br />Add 3 plumbing fixtures <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Modle house and sales office <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />S- JE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />IHE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR. AUTHORIZED AGENT, OR OWNER DATE <br />X" <br />�-G <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />8 6 Intercity Di i. 1 <br />LOT _ BLOCK _- OF <br />JOB ADDRESS <br />60vergreen ay <br />J EW <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />I <br />WATER CLOSET (TOILET) <br />BATHTUB <br />5 <br />OO <br />A/C-A/HNDLG UNITS - H.P. <br />REFRIGERATION UNITS - H.P. EA. <br />I <br />LAVATORY (WASH BASIN) <br />SHOWER <br />5 <br />OO <br />BOILERS -BT.U/H.P. <br />GAS FIRED A C. UNITS - R.T.U. <br />KITCHEN SINK & 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 />I <br />CLOTHES WASHER <br />URINAL <br />5 <br />00 <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />DRINKING FCUNTAIN <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 />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL <br />$ 15 <br />00 <br />SUB TOTAL <br />PERMIT <br />S 10 <br />00 <br />PERMIT <br />TOTALFEE <br />S 25 <br />00 <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑No <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 />25 <br />00 <br />9ZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />03/11/87 12:1 INOOOF1N44'0 <br />LI. <br />FIRESPRINKLERS REQUIRED ❑ YES ❑ NO <br />INVESTIGATION FEE <br />jjOQQPJgJ <br />STATE BUILDING SURCHARGE <br />FLEG $2 i.00 <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />S.H. <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />TOTAL <br />25 <br />00 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SHAOt) 'MIS IS 1UUn rv.m' 1 00 <br />Cn <br />co <br />