Laserfiche WebLink
TBF Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />258.8745 <br />.APPLICATION FCti.l I <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL D PLUMBING ❑ SIGN <br />OWNER / MAIL ADORE98 CITY ZIP PHONE <br />.?C".0_5 <br />ARCNIIECl OR OElI[R _ GALL AUD�!! IIY ZIP PIIONE <br />46U //M <br />PLUMSINOCONTPACIOR MAIL ADDRESS CITY IP PIIONF LICE NSTF <br />CLL.�ASS OF WORN ❑ BUILDING RELEYCATIOIJ <br />IL NEW ❑ ADDITION ❑ ALTERATION El REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT <br />uec or su INo <br />.T� <br />„a a e <br />cJ'� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />(,''^L '- ' <br />/ <br />PLICATION AND KNOWTHE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LF.OAL DMM,plLONOr PIIOPEPIYISnOWN BELOW OR ATTACH FOUR COPIEN <br />C)c� <br />/gl;e <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT�BLOCP—Or t <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TIC VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTMCTOR OR AUTHORIZED AGENT DATE <br />Al, / ' d <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO44 <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />FEE <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />COND. UNITSN P. EA <br />_ <br />REFRIOERUNITS—H.P. UNITE—N.P. EA <br />PE <br />F <br />BATHTUB <br />O <br />I <br />LAVATORY IWASH BASIN) <br />0 <br />POILERS—N.P. EA. <br />— <br />SHOWER <br />JAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT 14EATERS-8.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYEAS <br />Sv <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 />— <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE It CHIMNEY <br />_ <br />_ <br />SINK SERVICE —BAR, ETC <br />WOODSIOVE/—FI-R°LACE INSERT <br />Le�.G <br />BUS TOTAL <br />BUB TOTAL <br />PER <br />• <br />_ PERMIT <br />TOTALFEE <br />t <br />S <br />TOTALFEE t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />'PONI :.ABACK <br />REAR SETBACK I <br />BIDE SETBACK I, <br />P.L•AZ�NFL-'NECB%UM� 1 <br />YY" <br />EEE '�LVN <br />CHECK FEE <br />RECEIPT NO <br />WE ZONE I <br />LOT AREA <br />y ANI SiIE <br />YEB ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE Or CONFBI`j <br />OCCUPnANCY GROUP <br />I-` - <br />NO Or UWELLINO UNITS <br />I <br />RUILDINO <br />/ ) �V'l <br />E AT` AooV <br />) <br />,Y(e�. <br />�J <br />/,p <br />,y� <br />E_ v <br />SItE Of BI00 <br />JV <br />G <br />n0 UT 410n1E9 <br />MAX OCC LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ONO <br />MECHANICAL <br />OTHER <br />PENALTY <br />p <br />/� <br />A 0 <br />{ <br />1/,) <br />APPIICAiIOH ACC By <br />PlAN9 CDECKEO BY <br />APPR FOR 199UANCF BY <br />TOTAL <br />