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;',PPLICATION FO.. lY2FlN <br />the Evergreen CONSTRUCTION <br />CITY OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK• PLEASE PRINT <br />❑ DEMOLITION Cl COMBINATION ❑ BUILDING 0ECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />OR <br />GENERAL CONTRACTOR <br />CITY ZIP <br />C1l1fVvJ��0 / Z'II'' <br />�GIIY ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION E-' ALTERATION ❑ REPAIR ❑ DEMOLIHON ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />/se o� RDNIa <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERI'AITDOES 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 />/ <br />a �. LL, <br />LEGAL O CRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT- BLOCK 0 <br />PROJECT ADDRESS <br />APPL TS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE— <br />NO. <br />I TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILER <br />AIR COND. UNITS—H. P. EA. <br />— <br />BATHTUB <br />—_ <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />/ <br />DOILERS—H.P. EA. <br />_ <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />DISHWASHER <br />W/.LL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />NIT IIEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />_ <br />_I <br />cVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />V -NTILATION FAN <br />DRINKING FOUNTAIN <br />RAN7E HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADE RS <br />METAL FIREPLACE A CHIMNEY <br />SINK(SERVICE—BAR, ETC. <br />WOODS I OVE/FIREPLACE INSERT <br />_ <br />_ <br />i- <br />7rLT gw�_TF�F_' <br />_ <br />TOTAL <br />SUBTOTAL S <br />✓� <br />_ <br />_ <br />PERMIT S <br />_ <br />PERMIT S <br />5 <br />_ <br />TOTAL FEE 6 <br />TOTAL FEE s <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPI. PERSONNEL <br />RONT SETBACK <br />RLANSEIGACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />'SE ZONE <br />— <br />LOT AREA <br />VACANT a:TE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />fPE OF CONS) <br />OCCUPANCY GROUP <br />I NO OF DWELLING UNITS <br />FIRE SPRINKLERS REOUIRED ❑ YES <br />ACC BY I PLANS CHECKED BY IAPPR FOR ISSUANCE BY <br />BUILDING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />71 <br />