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OF APPLICATION Ft)R <br />:ITY DT°F <br />Evergreenhe CONSTRUCTION O <br />everett PERMIT <br />TO BE COMPLETED !N BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />'59-8745 ❑ COMBINATION y BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />M1VNER MA ILADD RE SS wCITY ZIP PONE <br />s <br />BCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />1R?f Si�ldu� ::zro- 1 � 61 Ai�cs 100 ;f4f-z�;� <br />Mnl Anll¢ Sl .rUt .. CITY ZIP PHONE LICENSE. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE• <br />LICENSE <br />'LUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />:LASS OF WORK <br />❑ <br />x <br />❑ ❑ <br />❑ <br />BUILDING RELOCATION <br />❑ NEW ❑ ADDITION <br />ALTERATION REPAIR <br />DEMOLITION <br />WOODSTOVE/FRPLANSERT <br />PLUS LABOR) <br />JESCRISE WORK <br />am <br />GSE OF BUILDIN <br />lLP <br />I HE!TEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <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 Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUR401TFCOTORORAUTHORIZEDAGENT DATEx <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOWOR ATTACH FOUR COPIES/ <br />LOT _BLOCK L_OF <br />PROJECT ADDRESS <br />rN�r MAW W#d <br />APPLICANTLICENSE NG <br />(b3)1 �r ruin 0 3 <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 COND. UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />_ <br />SHOWER <br />CAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK SERVICE —BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL 3 <br />SUBTOTAL <br />PERMIT 3 <br />PERMIT S <br />_ <br />TOTALFEE 3 <br />TOTAL FEE 3 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK SIDE SETBACK PLANCHECKN MBER PPN CHECK <br />N / / - 5- X FEE F3 i I RECEII <br />5FL <br />RE ZONE <br />C,/ <br />LOT AREA <br />tN/, 4 <br />VACANT SITE <br />DYES XNO <br />'PE OF CONST. �/ . <br />Lxt$/G <br />OCCUPANCY GROUP <br />/7�Z <br />NO. OF DWELLING UNITS <br />BUILDING <br />ZE ORBE9Q C Sp4G, <br />ZS 6 <br />NO. OF STORIES <br />MAX OCC. I, ," <br />7// <br />PLUMEINO <br />IRE SPRINKLERS REQUIRED YES ONO <br />MECHANICAL <br />OTHER <br />PENALTY <br />>PLICATION ACC. BY <br />_I46 <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />FEES VALUATION I FEE <br />T <br />O D <br />3 <br />—1 m <br />2 <br />m� <br />t/1 <br />om <br />n PD <br />C v <br />m N <br />m <br />z c� <br />�m <br />n <br />O <br />m <br />m <br />