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9PPLICATION LOB <br />the Evergreen <br />CONSTRUCTION Ed]CITY OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />255-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER <br />M.qc >✓ 4' l�v,n <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP PHONE <br />yrc �i3r Mrcu S�rrL io/a [JILT IV/4 <br />MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />`I ZLCITYZIP PHONE LICENSE A <br />J3�B11.5%Z:,YCkN1�4 9Bo53 r,2-2coN2S-AoZ <br />MECHANICAL CUNIR <br />MAIL ADDRESS <br />PLUMBING CONTRACTOR <br />MAIL ADORESS CITY ZIP PHONE LICENSE• <br />CLASS OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIIION ❑ WOOUSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABORI <br />DESCRIBE WORK <br />LEl.� icA.l N=6 k—iELM- <br />L c T" QN1 r4/1-bL FiCu.r%' <br />USE DF BUIIDIrIc <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORREC"I. ALL <br />PROVISIONS OF 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 OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE / CTOR OR A/U/ HORIZED AGENTr DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES] <br />LOT__BLOCK _.oF <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE r•F EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNOLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS —11 P. EA. <br />LAVATORY (WASH BASINI <br />BOILERS — B.T.UIH. P. <br />SHOWER <br />GAS FIRED A.C. UNITS — B.T.U. <br />KITCHEN SINK S OISP. <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 />URINAL <br />CLOTHES DRYERS <br />ORINKING FOUNTAIN <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 A CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />_ <br />GA $ PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />sl <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />;RUNT SETDACK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST. <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />OTHER <br />_ <br />FIRE SPRINKLERS REOUIREC ❑ YES <br />❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />,L <br />PUBLICWURKS <br />TOTAL <br />PROPERTY OWNtHS Aht HtJru WJmLE FOR �cl cnlvnnlnv ncc <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />