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r <br />APPLICATION FOK�"*' <br />the Evergreen <br />CITY OF <br />CONSTRUCTION <br />evereR <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT m <br />l: <br />❑ DEMOLITION ❑ COMBINATION <br />❑ BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />OWNER <br />E vCN-2 <br />MAIL ADDRESS CITY ZIP PHONE <br />7s?,5&VNS I NL PORGY 7 C9 7 L-pi U Awd WCL �' 7 <br />ARCHITECT 0 UESIGNI, <br />l\, • C_,l =D ✓wl <br />IAAIL ADDRESS <br />P • I`6oz /�1Lu <br />CITY <br />2oi c t-. Se/w/Y <br />ZIP VHON <br />Wa. 98177 5`16- 96egZ. <br />GkNERA,L CONTRACTOR <br />MAIL ADDRESS <br />CII\' <br />TIP PHONE LICENSE• <br />�c)�,T.� <br />NF Sr•sn P <br />!jAZS 3(�7-�SRU <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />! CITY <br />21P PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE- <br />CLADS OF WORK <br />NEW ❑ ADDITION <br />❑ ALTERATION ❑ REPAIR <br />❑ DEMOL111ON ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK OF MA <br />RIAL5 PLUS LAUUM <br />1g �0)o <br />Lam - <br />r r Zsvo n��.�% <br />DESCRIBE WORK <br />LOSE OF BwkDINc <br />�c -I- Yl.i t" AJ <br />E THAT I HAVE READ AND EXAMINED THIS AP- <br />PLCATO AND KNOWTHE SAMETO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHIS 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 FERFORMANCE OF CONSTRUCTION. 1 <br />SIGNATUROF CONTRACTO OR AU L THORIZED AGENT OATS 3IZS I Q V " <br />X <br />LEGALOSWY <br />ESC IPl10N OF PPOPERTYISHOWN BELOW OR 1TACII FOU c sl <br />— <br />— <br />PROJECT ADDRESS <br />PLUMBING <br />APPLICANTSC Y BUSINESS LICENSE NO <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNOLG UNITS — M.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOIL EFS — B.T.U./H P. <br />GAS FI1IF.O A C. UNITS—B.T.U. <br />—SHOWER <br />NI:^.HEN SINK 8 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 />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADEf S <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC 1 <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL ii <br />SUB TOTAL <br />PERMIT S <br />PERMIT <br />TOTALFEE sl <br />TOTALFEE <br />PLAN CM CK NUMBER <br />�b 19R/ I <br />FEE �C <br />IJ-1- <br />RECEIPT D ID. 5 <br />FEE <br />1 AUNT SETBACK <br />REAR SETBACK <br />CIDE SETBACK <br />USEZONE <br />I <br />f <br />LOTAREA <br />IYA <br />VACANT SITE <br />OYESX10 <br />FEES <br />VALUATION <br />- <br />BUILDING <br />Go <br />g ly <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDGr <br />1176 sF <br />NO. OF STORIE� <br />MAX.00G LOAD <br />32' <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICAIICNACC BY <br />PLANS CHECKED BY <br />41 <br />APPR. FOR ISSUANCE BY <br />� /n�s <br />' fo n., <br />PUBLIC WORKS <br />TOTAL <br />PROPERT" UW NtHS AFIt MtbrUIN01 ULE F V M UE 1 Enmumm Au <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />