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the Evergreen . APPLICATION FO..' <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL d PLUMBING <br />❑ SIGN <br />OWNER c MAIL ADDRESS CITY SIP PHONE <br />/r1 e'Aa 411 �inc7� %'CJc'so� K59-->- ST.,�iY 98-2ssV G s'.3-.lam s— <br />GEVN�T.EE.,AL CONTRACTOR <br />MAIL ADOPESS <br />CITY <br />SIP <br />NIGHT: LICENSE • <br />/i-/-ifo <br />�er'"p 95 o6pr, <br />O <br />/%,,Cl4 %/76 a/ i <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE K <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />MOORE LICENSE IF <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />JA q,2 <br />2. OFnryIL0910L MATERIALS PLUSLABOR) <br />,500 <br />DESC IDE WORK - <br />USE OF BULL DING <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OFWORKWILLBECOMPLETED 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 CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SiGNA7URE Or CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DEWRIP71ON OF PROPERTY (SHOW (18EL OR ATTACH FOUR COPIIS) <br />LOI.:�L_BLOCK_or� ��'��` <br />PROJECT ADDRESS <br />API'TtAkFirs CII IFUSRIESS 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 (TOILED <br />C@ <br />AIR COND. UNITS-11R EA <br />BATHTUB <br />I� <br />REFRIGERATION UNITS—H P. EA <br />�f <br />LAVATORY WASH BASIN) <br />SHOWER <br />lLr7 <br />BOILERS—N.P. EA. <br />OAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B T.U. M EA. <br />DISHWASHER <br />_ <br />WALL HEATERS—B T.11 M <br />_ <br />LAUNDRY TRAY <br />_ <br />UNIT HEATERS—B T 11 M <br />CLOTIIES WASHER <br />EVAPORATIVL COOLERS _- <br />_ <br />CLOTN,y DRYLAS <br />URINAL <br />-A <br />i^ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— CF.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINI.EAOERS <br />METAL FIREPLACES CHIMNEY <br />SINK SERVICE —BAR ETC I <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL <br />PERMIT f <br />PERMIT f <br />_ <br />TOTAL FEE t <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />ETBACK REAR GE18ACK SIDE SETBACK PI AN CNECK NUMBER RAN CHECK FEE <br />% �� f+ FEEPECEI�1�_ <br />E LOTAREA yBCANT SITE •7 [rim«A TUC <br />')- / J'. ti'( M1 ONO I[Ef VALUATION I[[ <br />1 <br />C014ST OCCUPANCY GROUP NO OF DWELLING UNITS <br />(/ %li IF •' I 1 BUILDING I tA" ECX1/1� 2 <br />0,00 <br />9..j I, <br />M►4 <br />L.L.C. <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />7 <br />