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APPLICI ON FGA <br />mere" <br />theEvergreenCONSiRiJCTION <br />CITY Of <br />everett <br />PERMIT <br />�n <br />e <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />.`�'.. l <br />BUILDING DEPT. <br />259.8745 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />•-r _ _ _ n <br />MAIL ADDRESS CITY ZIP <br />n ,, -, 7,"I 4 , R. J. O n <br />PION: <br />3 <br />YR- `16.3n <br />GENERAL CONTRACTOR MAIL ADDRESS CRY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WOR.< <br />❑ NEW ER ADD:T:oN ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST 01 MAIERIALS PLUS LABOR) <br />- <br />DESCRI E WORK / <br />/..AP'T <br />1' 1 - <br />USE OF BUa ING <br />C.A�t /o FRiLGRPEPLICATI.ONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />- - <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <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 />ANY OTHER STATE OR LOCAL LAW REGULATt NG CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X 4- iZLol-Hs- <br />LEGALDE CPIPTIONERT ISHOWNBELOW OR ATTACH FOUR COPIES) <br />I.D7_ BLOCK. <br />PROJECT ADDRESS <br />7099 Low ,fe-A RADGF RD <br />PLUMBING <br />APPLiopNrs CITY BUSINESS LICENSE NO. <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />/ <br />_ <br />WATER CLOSET(TOILET) <br />D <br />AIR COND. UNITS-H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA, <br />LAVATORY (WASH BASIN) <br />CJb <br />BG:_ERS-HP. EA._ _ <br />SHOWEP <br />/ <br />GAS FIRED AC. UNITS-TONNAG : EA <br />KITCHEN SINK& DISP. <br />FORCED AIR St STEMS-B.T.U. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />I <br />CLOTHES WASHER <br />WATER HEATER <br />C� <br />Uc% <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />_. <br />DRINKING FOUNTAIN <br />Ys <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WDODSTOVE/FIREPLACE INSERT <br />' <br />SUB TOTAL <br />SUB TOTAL S <br />T-L� <br />_ <br />PERMIT f <br />PERMIT S <br />TOTAL FEE 4 <br />TOTAL FEE _ & <br />1 <br />L <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDESETOACK <br />PLAN CHECK NUMBER <br />o, l4O' <br />G�/ IJ �,7r �II <br />FEES <br />PIANCHECKFEE <br />FETE -L�-l� IRECc <br />ATION <br />- <br />PT NO. <br />DD <br />FEE <br />USE ZONE <br />rG..�� <br />LOi Al1EA/�/� <br />7 jV �� <br />VACANT SITE <br />DIES W40 <br />NO. OF DWFLLUIG UNITS <br />_. <br />BUILDING <br />TYPE Of CONST. <br />OCCUPANCY GROUP <br />K"s <br />SIZE OF SLOG. <br />IZ K �R An{7)J <br />NO. OF STORIES <br />S <br />MAX. CCC LOAD <br />PLUMBING — <br />ell- <br />I— �Gl <br />Oc", <br />FIRE SPRINKLERS REQUIRED ❑ YE!; NO <br />MECHANICAL <br />T . <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />1 <br />PLANS CHECKED BY <br />J <br />APPR. FOR ISSUANCE BY <br />Z ` <br />TOTAL <br />- G <br />z <br />