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the Evergreen APPLICATION FO everen <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑/MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER.{ MAIL ADDRESS / CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />1 MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />GT//t/�P"IT <br />C✓A f /l',Cf/cti, <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />C DoIg1c/1 <br />17)6c11uX/t,4 ) P6 8 10'/J— <br />-yil.r%)/Y'l/= <br />98'Lw <br />G; 3�V7ti <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />CLASS OF WORK <br />Q. NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MATERIALS PLUS LABOR) <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF 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 REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BE LOW OR ATTACH FOUR COPIES) <br />LOT_BLOCK —OF <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />_ <br />_ <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE LA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS-B, T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />t <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE d CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />r- <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEE S <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />O <br />n <br />m <br />