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IAA Evergreen <br />CITY OF <br />everett <br />BUILDING DEPT. <br />259-8745 <br />APPLICATION FCdZ evereN <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />y <br />15-y <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE <br />PI UMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE <br />CLASS OF WORK <br />❑ ❑ <br />Cl NEW ❑ ADOPION <br />Cl ALTERATION Cl REPAIR <br />DEMOLITION WOODSTOVE/FRPLANSERT <br />BUILDING RELOCATION_ <br />VALUATION OF WORK (COST Of MATERIALS PLUS LABOR, <br />DESCRIBE WORK <br />I). iI L - <br />I/ L /L9 U r I/ 1 r <br />USE r BWLBING <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 />pROVISI ONSOF LAWS AND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH rOURCOPIESI II <br />WNV L�-� L TT <br />�/ <br />TH <br />WORKWHETHER SPECIFIED HEE- <br />BE T^ <br />WTHE TO <br />Loz� LOC .L- (L <br />GRANILL <br />IONFOR NO NG OFDA PIERMIT DOES NOT PRESUME <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISID14S OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />CR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Li RA'OR OR AUTHORIZED AGENT DATE <br />^ L y Lam/ <br />PROIECTADDRESS <br />APPLICANTS CITY BUSINE LICENSE 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 COND. UNITS-H P. EA <br />_ <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />LAVATORY(WASH BASIN) <br />BOILERS-H P. EA, <br />SHOWER <br />GAS FIRED A C. UNITS -TONNAGE EA <br />KITCHEN SINK A DISK <br />FORCED AIR SYSTEMS -BTU. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS-8 T.U. M <br />_ <br />LAUNDRY TRr' <br />UNIT HEATERS-B T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE MOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />_ <br />SINK ISERVICE-BAP, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT 3 <br />PERMIT f <br />_ <br />TOTAL FEE f <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />v <br />c <br />