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the Evergreen `APPLICATION FOk "1,P„ <br />CITY OF CONSTRUCTION NMI <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS / CITY top PRONE <br />} <br />rcl:nT) 17/y' E� �'_ � Si • i-UrinJ,.TT �%y�'C'3 ss-'3`�y3 z <br />..,........•. nnneemuee uui AnnePRK CITY P PHONE I <br />4rF/:_ <br />LICENSE Y <br />PLUMBING CONTRACTOR MAIL ADDRESS CIiY ZIP PHONE LICENSE• <br />❑ NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAL UATION Of WORK IC(11T Of MAIERIALS PL W LABOR) <br />11/vr /L <br />DESCIUBE WORK <br />Of BUILDING <br />9 <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 />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <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 OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIL N <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE 0 ONE C OR OR AURNORIZED AGENT DATE <br />X c c. h — <br />LEGAL DESCRIPIKJNOr PROPERIYISHOWN BELOWOR ATTACH FOURCOPIESI <br />LOT— _-BLOCK_Of_ <br />/ E I /. n '_ ' l-J <br />_ <br />PROJECT ADDRESS <br />APPLICANI'B CITY B1191NF99 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 TOILE <br />AIR COND. UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H P. EA <br />LAVATORY WASH BASINI <br />BOILERS—H.P. EA <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK a DISP. <br />FORCED AIR SYSTEMS—G.T.U. M EA <br />_ <br />DISHWASHER <br />WALL HEATERS—BT.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />_ <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-RAINLEAOERS <br />METAL FIREPLACE! CHIMNEY <br />- <br />SINK SERVICE -BAR, ETC. <br />WOODSTO FIREPLACE INSERT <br />SUBTOTAL <br />al <br />CL- <br />SUBTOTAL t <br />�. <br />_ <br />PERMIT E <br />_ <br />Ix <br />PERMIT <br />_ <br />TOTALFEE ELO <br />TOTALFEE [ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />Zo <br />Zo <br />5 <br />S S 0 <br />1 E ,13 <br />RECR�NQ 0 y p <br />/ <br />EST ZONE J <br />R-� <br />LOIARC <br />�700 <br />VACANT 911E <br />OYES TNItl <br />e[!t <br />VALUATION <br />poll <br />TYPE Of CONS) <br />IZO—� 1 <br />.�^^ <br />OCCUPANCY GRvUP <br />- 3 <br />NO OF DWELLING UNITS <br />BUILDING <br />! <br />I,(�� L/�ILAI <br />1�•�/ <br />p <br />�f% <br />Sell <br />�Il <br />{yLI RI UQIt - 1 <br />x'Zp 1 ADON <br />NO OF STORIES <br />7 <br />a- <br />MAX OCC LOAD <br />PLUMBING <br />_ <br />FIRE SPRINKLERS REQUIRED ❑ YES "0 <br />MECHANICAL <br />OTNEN <br />PENALTY <br />— Q <br />I <br />sd <br />APPLICATION ACC BY <br />Pi ANS CIIECKkO BY <br />APPR FOR ISSUANCE BY <br />L, <br />�-- <br />TOTAL <br />