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the Evergreen•'��aNSTRU�Ti�N� <br />CITY OF <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION BUILDING � MECHANICAL <br />eve rest <br />PLUMBING ❑ SIGN <br />GIN Zlp PHONE LICENSE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />SAr,ts <br />ZIP PHONE LICENSE• <br />MAIL ADDRESS <br />MFCIIANICAL CONTRACTOR 1� 1 <br />CITY <br />C-✓�r�-� ,q_ exQ / p s •2.3/L <br />EJe�.n�A.., "IGTCJ S� 1•v"1G' � 11/ 1'��1Vs10. <br />YGIPNTr ?NONE LIC NSJE�• <br />PLUMeI NG Wr lIACTOR ^""` <br />9IL <br />L Cam/ �, 4 <br />A 13 J,n <br />-j lM Y�e-t6w4� �A)c f 13� <br />_ <br />CLASS OF WORN <br />❑ ❑ DEMOLITI7N <br />❑ WOODSTOVE/FRPL.INSERT BUILDING RELOCATION <br />NEW ❑ ADDITION ❑ ALTERATION REPAIR <br />V LUATION OF WORKICOST OF MAIEHIALS PLUS LA90R1 <br />DESCRIBE WORK <br />-re,na,7V <br />::;�= <br />THAT I HAVE READ AND EXAMINED THIS AP- <br />usEOFBUILDING <br />I HEREBY CERTIFY <br />PLICATION AND KNOWTHE SAMETO BETRUEAND CORRECT. ALL <br />Q�-� , <br />RDINANCES THIS TYPE <br />CRIPTION OF PRVERNING <br />LEGAL OESOPERTY SHOWN BELOW OR ATTACH FOUR COPIE51 <br />(S <br />OF WORK WILLL BE GOMPLETOED WITH WHEGHO ER SPEC FIED HERE- <br />OF A PERMIT DOES NOT PRESUME TO , <br />LDT—el.ocK_—oF <br />IN OR NOT. THE GRANTING <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 />NvrC • DES/ <br />r 2-11y�a� <br />APPLICAVTS CITY B0511 S 4CENSE NO. <br />PROJECTADDRESS 1/vv, I/ `� 7 �I��• Z <br />S. Cf <br />17 u3 _ <br />a <br />MECHANICAL FEE <br />PLUMBING FEE <br />NO. TYPE OF EQUIPMENT <br />NO TYPE OF FIXTURE / Ov <br />AIR COND. UNITS—H.P. EA. <br />I WATER CLOSET(TOILE1) <br />—1 <br />REFRIGERATION UNITS—H.P. EA <br />BATHTUB L;v <br />BOILERS—H.P. EA <br />LAVATORY (WASH BASIN) <br />GAS FIRED AC. IINITS—TONNAGE EA <br />_ <br />SHOWER <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />KITCHEN SINK OISP. <br />WALL HEATERS—B.T.U. M <br />DISHWASHER <br />UNIT HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER 12, <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HA14DLING UNIT— C.F.M. <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE 8 CHIMNEY <br />ROOF DFiA1NG—RAINLEADERS <br />WOOD51UY, )REPLACE INSERT <br />SINK SERVICE —BAR. ETC. <br />SUBTOTAL $ <br />SUB TOTAL <br />PERMIT 5 <br />PERMIT S Ir <br />TOTAL FEE f <br />TOTAL FEE 5 <br />BY BUILDING DEPT. PERSONNEL <br />THIS PORTION TO BE COMPLETED <br />FRONT SETBACK REAR SETBACK SIDE SETBACK <br />PLAN CHECK FEE <br />PLAN CHECKN MBER 7 �� <br />/// oc, FEF n--� �J R EIP - <br />3v <br />USE ZONE LOTARE�,AAAYY�, VACANT SITE <br />FEES VALUATION FEE <br />OYES ;T10 <br />^/ AI <br />ttPE OF CONST OCCUPANCY GROUP NO. OF DWELLING UNITS <br />A. %�• .Z Q <br />$�O <br />BUILDING <br />ACC. BL <br />L� 1 J <br />`U t/ <br />L -G <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />i <br />z <br />0 <br />n <br />m <br />N m <br />m <br />0 <br />mo <br />0 3 <br />m <br />S � <br />m <br />�z <br />—1 N <br />C D <br />K <br />—i m <br />Fn <br />m .-i <br />O <br />o r <br />7 m <br />C (/1 <br />3 N <br />z ('T <br />A <br />