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A &PPLICATION FO.. <br />evereR <br />she Evergreen CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8745 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION Il BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAII ADD E5S CITY TIP <br />�` NAB Ciu1�1 iEl� l�lt� 'IAf� {��r I�W'1 524J1 uv U-it' I* 1162a, <br />PHONE <br />25 14 <br />--ySf <br />ARCHITEClORO 51f.NER <br />�1��rvV+t� A�calnrz;�rtn>h'1 <br />MAII ADDHCSR CITY ZIP <br />l�nr N�Ilulhu� I7�>, r�su�lrr�y��1j 90zL)r�j <br />PHONE <br />3I I <br />GENERAL CONTRACTOR <br />MAII ADDRESS CITY ZIP <br />PHONE <br />LICENSE. <br />MECHANICAL CONT^ACTOR <br />MALL ADDRESS CITY ZIP <br />PHONE <br />LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PIIONE <br />LICENSE. <br />:LASS OF WORK <br />❑ NEW ❑ ADDITION LTERATION ❑ REPAID ❑ DEMOLITION ❑ WOODSTOVEIFRPL. INSERT ❑ BUILDING RELOCATION <br />S PI HIS I ABORT <br />DESCRIBE WORK <br />r .ti.wA.\-T- Imoononssvu-,S ' <br />USE. OC B 10 G - <br />�� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />13LICATION AND KNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <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 OP <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFOR�E OF CONSTRUCTION. <br />SIGNATUHL OF CO OIACt0 A T RILLD AGLNT DATL <br />KYi . <br />I FOAL DESCRIPTION OF PROPERTY IBIIOWN NCI OW ON ATTACH I OUR COMCSI <br />Ip ]j,� -1 _ <br />LOT IT2U%LOCK r��oF_ �' - <br />--- <br />PROJECT ADDP SS <br />O e- <br />APPI ICA I S CITY DUSINE55LICLN NO <br />PLUMBING __ _ <br />_MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />_FEE— <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR CONO UNITS -II P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />_ <br />LAVATORY(WASH BASIN <br />_ <br />_ <br />BOILERS-II.P. EA <br />_SHOWER <br />_ <br />_ <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP. <br />_ <br />_ <br />FORCED AIR SYSTEMS-B.T.0 M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-BT.U. M <br />CLOTHES WASHER <br />-- <br />EVAPORATIVE COOLERS <br />_ <br />WATER THEATER <br />_ <br />CLOTHES DRYERS_ <br />_ <br />URINAL <br />_ <br />_ <br />_ <br />VENTILATION FAN <br />- <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />__ <br />AIR IIANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAIN S-RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINKISBRVICE-BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />-- <br />SUB TOTAL It <br />—_ <br />-- PERMIT Is <br />- — <br />PERMIT <br />TOTALFEE S <br />- <br />-- <br />_ <br />Jc - 7 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK SIDE SRBACn PLAN CIIECK N HOER PI AN CHECK FEE /' % <br />VA �(, � !.�' I I `� I FEE " RECEIPT NOS/ Lt7 <br />IOTA VACANT SITE (-E <br />FEES VALUATION FEE I <br />TYPE OF CONST <br />-N <br />SIZE OF BLDG <br />24 <br />FIRE SPRINKLERS RE <br />IIYLS A40 <br />CCLIPANCY GROUP <br />NO Or Dl1ELIINILINIT5 <br />'s - t <br />ew ..4n CG. <br />O OF STORIES <br />MAX OCC LOAD <br />2-e64uI <br />ai <br />III ANS CHECKED BY <br />L.G <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />