Laserfiche WebLink
;-APPLICATION FOr-kI evereN <br />the Evergreen CONSTRUCTION <br />CITY of lacmi <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION ❑ BUILDING x MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER n('� MAIL ADDRESS CITY ZIP PHONE <br />'Fc,xU ,-S I`tli) cir\r� �'� ••_rct &Q7 E Eve.raAA- Malhskv ierel+ 98,90t/ .�3g3-3& <br />ARCHITE RDESIONER MAIL ApO E S Cltt ZIP PHONE <br />UENENAL GUNINAU IUH <br />mgIL gVUtlCJJ <br />� <br />ur rnvnc <br />cmcn Jca <br />�Att.Ey IVATrxRRf <'-fi�,Jl,3�3 <br />/iLJY `19, <br />�'vere�-F'F-q�l%D`i <br />/� <br />T�iS�•'7'73D VALLENlr-/53-L <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP PHONE <br />LICENSES <br />OF WORK L S <br />NEW ❑ ADDITION <br />❑ ALTERATION ❑ REPAIR <br />❑ DEMOLITION <br />❑ WOODSTOVEIFRPL. INSERT ❑ <br />BUILDING RELOCATION <br />ln5+ajla1',00 (7n8 S•1r.�P <br />USE OF BUILDING �r l <br />iQfi L�r= <iF2 EF_.XL !yC <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BETRUEAND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <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 PEGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X //16A <br />LEGAL DESCFIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK OF <br />PROJECT ADDRESS ccy)urf <br />Same <br />APPLI NTS CITY BUSINESS LICEN ENO. <br />EVT"ICr450 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />AIR CONn. UNITS—H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />nl'a1WARllrn <br />LAUNDRYIHAY <br />WAII IIFATFnR-nT II. M <br />UNIT HEAIERS—B.LU. IM <br />OO <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <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 />as <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT 5 <br />0 <br />00 <br />TOTAL FEE S <br />TOTALFEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />z <br />0 <br />m <br />m <br />_I <br />r <br />