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the Evergreen r:PPLICATION FOi y/ everett <br />CITY OF CONSTRUCTION <br />everett PERMIT e <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING 15� SIGN <br />OWNER MAIL AODNESS l CITY ZIP PHONE <br />G i NC /rIG nitisP /nP I// IyDZ SF j/hvc�l97n//lcir4 Fevre& iFF70y <br />ARCHIT EOT OR D ESIGNER MAIL Ap ESS CITY ZIP PIIO F <br />G//E//NCRALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />ftIf nl�/i /✓cl••I�HIrcF //has-.VE'//L Fb k-/rkhi ,d �/k t'321 / 3-3ioo //Pa//1 iL33a �27 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CONTRACTOR <br />MAIL ADDRESS <br />0 NEW ❑ ADDITION ❑ ALTERATION <br />❑ REPAIR <br />❑ DEMOLITION <br />❑ <br />WOODSTOVE/FRPLANSERT <br />❑ <br />BUILDING RELOCATION <br />VALUATION OF WORK (CO�[QF MATERIALS PLUS LABOR) <br />1 cy lwy) 6J <br />UCJIiXItlt W�/UXK L / �A �\\ <br />H <br />USE OF BUILDING <br />• _ _ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIf D THIS AP- <br />/ / <br />PLICATION AND KNOWTHE SAME. TO SETRUEAND CORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEG L E.a RIPTIONO PROPERTYIBHOW14 BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT— BLOCK _0 <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />APPLICANTS CITY BUSINE10 LICENSE NO. <br />'PROJECT ADDRESS <br />y. <br />'0 L� amil <br />32 0/</ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE CF FIXTUIIE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSETITOILET) <br />AIR COND UNITS—H.P. EA. <br />BATHTUB <br />_ <br />REFRIGERATION UNITS—H.P. EA <br />AS LAVATORY(WASH BIN) _ <br />BOILERS—H.P. EA. <br />SHOWER <br />_ <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SVbTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL NEATENS—B.T.U. M <br />LAUNDRYTRAV <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />_ _ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />-J <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />SINKSERVICE—BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />SUBTOTAL <br />SUB TOTAL 5 <br />_ <br />PERMIT 5 <br />PERMIT 5 <br />TOTALFEE $ <br />_ <br />TOTAL FEE 5 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK I REAR SETBACK I SIDE SETBACK I PLAN CHECK NUMBER <br />VACANT SITE <br />OYES ONO _ _ FEES <br />OCCUPANCY GROUP I NO. OF DWELLING UNITS — <br />BUILDING <br />NO. OF STORIES I MA%. OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />TED D YES Cl NO <br />OTHER <br />PENALTY <br />PLANS CHECKED BY r PPR. FOR:SGULNCE BY <br />I TOTAL <br />FEE IRECEIPT NO. <br />VALUATION I FEF. <br />1 r-V 7 <br />