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`APPLICATION FVC: R everen <br />!ne Evergreen CONSTRUCTIONCltt OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER �7 MAILADORESS CITY, ZIP PHONE <br />lv-n/ P/),,OAC //_//-/�,lYc�T <br />IJ <br />MAIL <br />MAIL <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />VALUATION f WOnK(COST OF MOVIALS PLUS LABOnI <br />�OcrJ�rrl—fl <br />CITY ZIP PHONE LICENSE <br />3e x �7cuS %�f�,Pr.�� 9�a03 33� S��a��DAD1n,G7-a3�n <br />CITY ZIP PHONE LICENSE <br />CITY ZIP PHONE LICENSE <br />REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />•^n 1 6_ / ,_ , d /l r, rlc"7,1 , OC 0,—. ter) 7_ SG -CA I LY O-O <br />c c , AP,- _- _ _ <br />USE OF BUILDING <br />�PS1�P n/ C P <br />_ <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 />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL RE COMPLETED WITH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OFA PERMIT DOES 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 />SIDNAII�I�E O� r CCOONTR<CT AeR AUT ORI AGENT DATE <br />X -` w/ <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT -_BLOCK OF <br />PnOJECT ADDRESS G <br />APPLICANTS CITY BUSINESS LICE ENO. <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 />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY IWASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTALFEE S <br />TOTALFEE f <br />_ <br />USE ZONE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />LOTAnEA VACANT SITE <br />OYES ONO FEES VALUATION FEE <br />OCCUPANCYGROUP NO. OF DWELLING UNITS <br />BUILDING f <br />NO OF STORIES MAX OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />RED ❑ YES ❑ NO <br />OTHER <br />PENALTY <br />PLANS CHECKED BY APPR. FOn ISSUANCE BY <br />TOTAL <br />