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TAB Evergreen APPLICATION FOL- <br />CITY OF CONSTRUCTION e <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />......en - . MAIL AnnAFRS Cm ZIP PHONE <br />MECHANICAL CONTRACTOR MAIL ADOR EBB .CIF/ ZIP PHONE LICENSE• <br />LICENSE A <br />-ucw n ATTENTION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT Cl BUILDING RELOCATION <br />USE o• BUILOIN3 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />ren t.1 <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF CAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEG, OESCMPTIINOEPPOPERtv1R4UWNBELOWORATTACHFOVRCOPIEW <br />(� I I <br />OF VORKWILL BECOMPLETED WITH WHETHER SPECIFIED HERE - <br />LOT 19 BLOCKL_OF I✓t,,IA "PT <br />INJRNOT. THE GRANTING OFAPERMIT DOES NOT PRESUME TO <br />61VE AUTHORIT" TO VIOLATE OR CANCEL THE PROVISIONS OK <br />I: <br />EGULA INGCONSTRUCTION <br />jots, At, a a(cor11nE 'In 1ITt CCOYr��Y� <br />OR THEPERFORMANCEOALLAWREGULATING <br />1... <br />DATE <br />1 n 1 C Il� /Llfk P( <br />SIGNATUREOFONTRAC R R AUTHORIZED AGENT <br />PROJECT ADDRESS <br />APP CAbftscrl S SI ESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENi <br />FEE <br />WATER CLOSET(TOILET)_ <br />_ <br />AIR COND. UNITS-H, P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA <br />-y <br />LAVATORY WASH 13ASINI <br />4 <br />BOILERS-H.P. EA. <br />SHOWER <br />OAS FIRED AC. UNITS -TONNAGE EA <br />- <br />e <br />KITCHEN SINK DISP, <br />FORCED AIR SYSTEMS-OT.U. M EA_ <br />f. <br />DISHWASHER <br />(j <br />WALL HEATERS-B.T.U. M _ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHEREVAPORATIVE <br />COOLERS <br />c�x7-) <br />i <br />WATER HEATER <br />CLOTHES DRYERS —, <br />_ <br />URINAL <br />/- <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 />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE t CHIMNEY <br />_ <br />SINK SERVICE —BAR. ETC, <br />WOODSTOVE/FIREPLACE INSERT <br />SUS TOTAL <br />BUD TOTAL IT <br />Gg- <br />V <br />_ <br />PERMIT t <br />PERMIT <br />TOTAL FEE t <br />TOTAL FEE t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />IRUNT SETT�BACK <br />c) USE toNl <br />FZ-2- <br />TYPE OT CORSI <br />3Z-N <br />SITE Or BI DU <br />.P31 h3, S28m•I <br />IRON ACC BY <br />LS 4 <br />LOT ART <br />7-! OU <br />VACANT BITE <br />AWYES ONO <br />OCCUPANCY GROUP <br />R-Zl*M•1 <br />NO OF DWELLING UNITS <br />2 <br />BUILDING <br />NO Or STORIES <br />/ <br />MAX OCC LOAD <br />-7 <br />PLUMBING <br />RED O YES X NO <br />MECHANICAL <br />-_ <br />OTHER <br />PENALTY <br />PLANS WRECKED BY <br />CC C <br />�L ! <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />nECEuPT"No <br />VALUATION FEE <br />