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s-:PPLICATION FOkr' everen <br />the Evergreen CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. / <br />259-8745 OR COMBINATION ❑ <br />BUILDING <br />❑ <br />MECHANICAL ❑ <br />PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />�YyS ���rEA7trt/ Go7S•E f✓dlEsr <br />/+1�/Lt /JeY <br />E✓�,te77" 98.Ze <br />T <br />/� 77/•7/,i/ <br />ARCBITECTORDF.SIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />77/•71,I/c2.36S 7�/UU <br />E�,hWXOtQ 4AE'yoS.IJ. <br />�LoiR.�oe✓ <br />i%�A/s,E <br />�A. 98037 <br />y <br />_ __�47 <br />GENERAL CONTRACTOR L:AILADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />21P <br />FIIONE LICENSE s <br />vAmLf <br />PLUUKIBI14G CONTRACTOR MAR ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />/TOQ'/A/SOAI lS.f P!J/NBBi2S� O7 . �F <br />7 MMIL <br />GI,OY LY <br />ifF7Y 9P.70•I <br />c❑ssWORK NEW ❑ ADDITION 0a ALTERATION ❑ REPAIR <br />❑ <br />DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />Z <br />O <br />ILLATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />r�-I <br />$23. <br />:eve <br />— <br />m <br />eo Ll V. <br />YT[ OOYw I cn <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />✓ji,EA/ <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THISTYPE <br />L-GAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />LOT �_BLOCK _—OF <br />IN OR NOT. THE GRANTING OFA PERMITDOES NOTPRESUMETO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />—t <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />ass--8s_ <br />PROJECTADDRESS <br />APPLICANTS Y D)SINE5S LICENSE NO. <br />G o 7 S f f✓d l6n <br />I/ <br />PLUMBING <br />MECHANICAL <br />NO. <br />OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_TYPE <br />WATER CLOSET (TOILET) <br />- 4 <br />e3a <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY(WASH BASIN) <br />CI(i <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />L <br />KI ICI 11 UINIL n UI:R• <br />I(1110EN Al 11 :Y':Ifh10 G1.(T MrA <br />_N <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />_ <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS_ <br />WATER HEATER <br />_ee_l, <br />CLOTHES DRYERS <br />_ <br />URINAL <br />OD <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />_ <br />RANGE HOOD <br />7. <br />FLOOR DRAIIJ <br />(70 <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />E/FIREPLACE INSERT <br />SUB TOTAL <br />SUB _TOTALS <br />PERMIT $ <br />PENMIT 5 <br />TOTAL FEE S <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />--- N A <br />SIDE aLIUAW <br />USE ZONE <br />LOT AREA <br />/%� �, <br />VACANT SITE <br />OYES RHO <br />TYPEOF CONST. <br />1L�/NZ <br />OCCUPANCYGROUP <br />11-3 <br />NO. OF OWEL <br />SIZE OF BLDG, <br />NO. OFSTORIES <br />MAX. OCC. LC <br />FIRE SPRINKLERS REOUIRED ❑ YES Of NO <br />APPLICATION ACC. BY <br />r <br />V <br />PLANS CHECKED. BY <br />APPR FOR IS <br />UNITS <br />IIY�b l FEE /Vj9. <br />FEES VALUATION <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />arils <br />NO <br />020 <br />FEE <br />As- <br />/ 73 - <br />