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the Evergreen ' P L I CATION FO k. <br />CITY OF CONSTRUCTION ` <br />everett PERMIT <br />BUILDING DEPARTMENT 1--- <br />259-87 5 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDRESS Cltt ZIP PHONE <br />11nrL.non-I -r- �F�S <br />MAIL <br />GENEF'ALCONTRACTOR <br />MAIL ADP'ICSS <br />CITY ZIP PHONE <br />4CENSE� <br />MECHANICAL CONTRACTOR <br />m _ I I I <br />MAIL AOURESS <br />Cltt ZIP PHONE <br />LICENSE <br />ma <br />ElNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ClDEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />L, to IU GDG 14 IJ'n FPIc' <br />USE OF BL'IL M G <br />_ <br />L-lye` <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOWTHE SAME TO BETRUEAND CORRECT. ALL <br />LEGAL DISC RIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LOT _BLOCK __oF_ <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PROJECTApORESS lWYJ �V CKC.L��II1,. 11 J <br />pppLICANTB CITY BUSINEBS LICENSE NO. <br />yoefW)ousE'r-ccol"ols �JeILQ.1r,I111b. / <br />7956 a) <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR GONG. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED 0.C. UNITS -TONNAGE EA rp <br />KITCHEN SINK & DISR <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 />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />C.F.M. <br />VACUUM BREAK'�'RS <br />ROOF DRAINS- RAINLEADE HIS _ <br />HIMNEY <br />SINK (SERVICE. _E'AR, ETC.) <br />E INSERT <br />hl sI <br />RWOODSTOVE/FIREPLACE <br />SUB TOTAL <br />BTOTAL 5PERMIT <br />5 <br />RMIT 5 <br />_. <br />TOTAL FEE & <br />TOTAL FEE 5 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL. <br />