Laserfiche WebLink
`APPLICATION FOX <br />` `evefetl <br />the Evergreen <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 <br />❑ COMBINATION BUILDING MECHANICAL <br />PLUMBING <br />❑ SIGN <br />OWNER <br />ILrADDRESS ZIP <br />PHH/O/NE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />PNNI <br />Id, <br />LICENSE LICENSE e <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP // vnone - Lwcnse• <br />,43(Af l rn-D _)YI �D G <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />CLA SOF WORK <br />NEW ❑ ADDI?ION ❑ ALTERATION ❑ REPAIR Ci DEMOLITION ❑ WOOD STOVE/ FRPL.I N SERT ❑ BUILDING RELOCATION <br />VALUATION OF WOdfAC( ST OF MATERIALS PLUS LABOR) <br />OESCRIP6 WJIIK <br />el a X/ _k A <br />USE OF BUILOING� J ' <br />! <br />I HEREBY CERTIFY TJI/I T I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAINDKNOWL HE SAME TO BE TRUE ANDCORRECT. 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 OF A PERMIT DOES NOT PRESUME TO <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. <br />SIG NATUREIOF CONTRACTOR H AUT a AGENT DAT <br />n <br />APPLIOAN TS CITY BUSINESS LIOER N <br />\\ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR OOPI-S) <br />/ <br />LOr ( BLOCK --_OF <br />f_ dOL <br />^l <br />c. <br />Gr <br />PROJECT ADDRESS <br />r <br />6)5 Z_5`ns <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE <br />7EE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSE T ITOI LET) <br />AIR COND. UNITS—H.P. EA. <br />BATHTUB <br />Ui <br />REFRIGERATION UNITS—H.P. EA. <br />-� <br />LAVATORY (WASH BASIN) <br />m <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK 8 DISP. <br />_C <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISHWASHER <br />C2) <br />WALL HEATERS—P.T.U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />_ <br />CLOTHES WASHER <br />VolEVAPORATIVE <br />COOLERS <br />WATER HEATER <br />Lk% <br />CLOTHES DRYERS <br />URINAL <br />1 ' <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />S <br />"-- <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />r <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />SINK SERVICE —BAR. ETC. <br />METAL FIREPLACE & CHIMNEY <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />SUB TOTAL <br />_ <br />A-v--r <br />_ <br />SUB TOTAL $ <br />h — <br />--I <br />PERMIT $ <br />PERMIT S <br />1&7Z/ <br />T <br />TOTAL FEE S <br />S <br />`� <br />TOTAL FEE 5 + ' <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />VCK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />/ T all <br />` FLc d/ ! RECEIPTN�3 Y <br />LOTAREA VACANT bl TOTE (IYu •l <br />_ �O `Jr {YES ONO FEES VALUATION FEE <br />TYP O OONASS T.OCCUPANCY fRCUP NO. OF DWELLING UNITS <br />V P— 3 BUILDING S ��• 37$ l t l <br />SIZEOF BLDO. NO. OF STORIES MAY. OCO. LOAD <br />' PLUMBING ZO QO <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />HALTY <br />APPLICATION PCC. By PLANS CHECKED BY APPR. FOR ISSUANCE BY <br />TOTAL <br />a C> ,v <br />