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��'PLICATION ��R e�� <br /> fhe Evergraen C�N SY R U C T I O N <br /> CIiY OF <br /> evere�.t PERMIT <br /> TO BE COMPLETED IN B�ACK INK— PLEASE PRIN�f <br /> BUILDING DEPT. <br /> 259•8745 u COMBINATION ❑ BUILDING ❑ MECHAN�CAL ❑ PLUMBING ❑ SIGN <br /> 014NER MARA00t1E55 W Cltt ZiP PHO4E <br /> II�!"�.I� �//� J L II �i� /� �� Ti V�'�C�`QC Z�D Z� ' PMO��O �__ <br /> ARf.HITECTOP0E51GNER MAILADORESS <br /> GENERALCONiPACTOR MAR AODRESS Lltt ZIP PHONE UGENS[n <br /> MECHANiULCONTP�LTOfl MAILADOFESS CIT! ZIP PHON[ UCENSEv <br /> PLUMBMG CONTRACTOR <br /> MhIL 40�RES5 CiPI ZIP PMONE LICENSE_ <br /> CLAS$OF N'ORN <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION WOODSTOVE/FRPL.INSERT _ BUIL�ING RELOCATIOId <br /> VAWATION OF WORK�COST OF M/iERIALS PL115 LABORI � <br /> � <br /> C� <br /> �� <br /> �ESCfiiBE WORN ,. <br /> ( �� � . Sl��� <br /> useoF avi�mna I 4EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- '"' "-" <br /> � Ti <br /> � � PLICATIONANDKNOWTFIESAMETOBEfRUEANDCORRECT.ALL <br /> LEGAL OESCRIPTION OF�FOPEflTV ISNOW N BELO W 9R RTTACH FOUR COPIES <br /> PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHIST �PE '""""'{ <br /> OF WORK WILL BECOMPLETED WITH WHETHEF SPECIFIED�; aE- � m <br /> �or_e�ocn—oF IN GR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUtr.�TO <br /> GNE AUTHOHITY TO VICLATE OR CANCEL THE PROVISIONS OF m o <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON <br /> OR THG PERFORMANCE OF CONSTRUCTION. o m <br /> SIGNATUREOPCONTR TORO UTHORIZEDAGENT DATE _ � <br /> m <br /> X � <br /> �1D � � Z� � .� z <br /> APPLIC/NTSCIT': USMESSLiG NSENOJ D � <br /> PnOJECTAODRESS ,(,L ti H <br /> )�. 1 I - �3� - � " <br /> MECHANICAL T <br /> rLUMBING FEE � D <br /> Np, TYPE OF FIXTURE FEE NO. TYOE OF EOUIPMENT <br /> WpTER CLOSET�TOILEn AIR COND. UNITS—H.P.EA '"'� m <br /> _ <br /> BATHTUB REFFIG[RATION UNITS—H.P. EA fT1 � <br /> LAVATORY�WASH BASINI 801LER�N_P.EA. O <br /> SMOWER GAS PtRED A.C. UNITS—TONNAGE EA _ �Ri <br /> FORCED�IR SYSTEMS—B.T.U. M EA. C N <br /> KI'iCHEN SIHK&DISP. m � <br /> DISHWASHER WALLHEATERS—B.T.U. M Z n <br /> LAUNDRV TRAY UNIT HCATEFS—�.T U. M � r <br /> m <br /> CLOTHES WASHER EVAPORATNE COOLERS � <br /> CLOTHES DRVERS A <br /> VJA7ER HEATER —� <br /> VENTILATION FAN 2• <br /> URINAL L <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HPNDLING 11NlT— C.F.M. ,� <br /> VACUUIdBREAKERS STOVE � <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLFGE 8 CHIMNEV � U <br /> SINK�SERVICE—BAR.ETC. WOODSTOVE,'FIREPLACEINSERT z <br /> C <br /> _ J <br /> I-+ <br /> _ r <br /> � <br /> — SUB TOTAL S <br /> SUBTOTAL S O <br /> PERMIT S PEFMIT <br /> TOTALFEE S TOTALFEE s � <br /> THIS PORTION TO BE COMPLEI'ED BY BUILDING DEPT. PERSONNEL <br /> PLAN CHECH N WdBER PLAN GHECn Fk'[. <br /> VBONi SEiBACK PEAR S[TBAGN SiDE SEIDACK qECEIPT ND. <br /> FEE <br /> USEZONE LOTAFEA VACANTSiTE FEES VRLUATION FEE _ <br /> �VES �NO <br /> TVPEOFCONST. OCCUPANCYGROUP NO.OFDWELLW�UNITS <br /> BUILOING S <br /> 512[OF�lOo. NO.OFSTOFIES MAXOGGIOAD <br /> PLUM8ING <br /> 1 <br /> MECh1ANICAL J L <br /> FIRE SPRINKLERS REOUIFiED ❑ YES ❑ NO OrnER <br /> PENALTV <br /> qFnLICATIONAGCBV PLANSCHECKEDBY APPR.FORISSUAN-EBY I �� --O <br /> TOTAL <br /> I <br />