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i XPLICATION FOl ' evereq <br />the Evergreen CONSTRUCTIONCITY OF <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATIONN Ll BUILDING <br />/v ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />IP <br />owyeR '. /n_ �n� �r� 0 E.Z. l c,-�V"'1 YilxR� Z/ Y .2 CJ� PHDZNE'1 L� /`;' <br />�/ If <br />ARCHITWT OR DESIGVtR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY ZIR <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE• <br />;L DING CONTRACTOR MAIL DDRESS <br />CITY -7-C �C ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORNvv�� r <br />[I NEW R[ ADDITION ALTERATION ❑ <br />REPAIR ❑ DEMOLITION ElWOODSTOVE/FRPL.INSERT ClBUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />J <br />DESCRIBE WORN 'I <br />,J'7 AAA//r <br />r[ civ <br />USE OF BUILDING d� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNI NG TH IS 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 />v-3�—�1� <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT_B4OCK_OF <br />PROJECT AD' ESS <br />APPLICANTS CITY BUSINESS LICENSE No a/ 3Ga,7 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />C <br />WATER CLOSET (TOILET) <br />O <br />AIR COND. UNITS—H.P. EA. _ <br />BAi HTUB <br />60 <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY IWASH BASIN) <br />0 <br />BOILERS—H.P. EA, <br />SHOWER <br />00 <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. <br />0 0 <br />FORCED AIR SYSTEM-,— B.T. U. M EA. <br />WALL HEATERS—B.T.U. M <br />_DISHWASHER <br />LAUNDRYTRAY <br />_ <br />__ <br />OO <br />UNIT HEATERS—B.T.U. M <br />—� <br />CLOTHES WASHER <br />__2 <br />2 <br />no <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />_ <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />U <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS— RAI NLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE —BAR ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />I' <br />i <br />SUB TOTAL S <br />PERMIT $ <br />PERMIT S <br />TOTALFEE S <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />wL CUrvc <br />wi <br />VACANT SITE <br />DYES ONO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG. <br />NO, OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES O NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC, BY <br />�n n <br />PLANS CHECKED BY <br />APPM FOR ISSUANCE BY <br />TOTAL <br />FEE I RECEIPT NO. <br />FEES I VALUATION I FEE <br />S <br />