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'PPLICATION FO1J evereB <br />the <br />EvergreenCONSTRUCTION <br />cln of <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING WMECHANICAL PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CRY ZIP PHONE LICENSE <br />n2v2r�u�1 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />A/h219bNZ-�_ In L- pv P,bx �? V 3' Lid m'ouos 'm o -7 -i '-6 zao -mil <br />31NG CONTRACTOR <br />I.2pOx�' %7'1 L <br />OF WORK <br />NEW ❑ ADDITION <br />LION OF WORK (COST OF MA <br />22.a on <br />ADDRESS <br />❑ ALTERATION <br />IDE WORK I <br />'ur Ayt,U' f / &-A- Fri <br />PHONE LICENSE - <br />STATE- A/R A D M 'L- <br />❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.I NSE PIT ❑ BUILDING RELOCATION <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMITDOES NOT PRESUMETO <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. // C <br />SIGNATURE OF C T ACTOR OR AUTHORIZED AGENT DATE <br />X y L <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK 0 <br />PROJECT ADDRESS <br />41os-- s. �. 45vE7zr7r mAt- ,� <br />APPLICANTS CITY BU '•NE S LICENSE NO <br />N 9 7 <br />PLUMBING <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 />L,4rf(r <br />A/C - A/HNOLG UNITS - H.P. , <br />BATHTUB <br />REFRIGERATION UNITS -H.P. EA. <br />LAVATORY ( WASH BASIN) <br />coBOILERS <br />- B.T.U./H.P. <br />SHOWER <br />GASFIREDA�C. UNITS-B.T.U. <br />KITCHEN SINK & DISP. <br />p' <br />FORCED AIR SYSTEMS - B.T.U./2.Nn EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />- <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. 320M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHESDRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />3 <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />Z <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />4flWOOD <br />STOVE <br />2 <br />SINK(SERVICE - BAR. ETC.) <br />METAL FIREPLACE A CHIMNEY <br />cz 2 F4 SE+ <br />FIREPLACE INSERT <br />HEAT PUMP <br />_ <br />GASPIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT S <br />PERMIT <br />TOTAL FEE S <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SBTBSLK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF CONSi. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC By <br />I PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FUH UEI hHMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />