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TM Evergreen <br />CITY OF <br />everett <br />BUILDING DEPT. <br />259•J745 <br />PPLICATION E(E..aP rYe7e„ <br />CONSTRUCTION IAMI <br />e <br />PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT ,.,, � <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL L7 PLUMBING ❑ SIGN <br />DIY <br />GENERAL CON( A R <br />MAIL ADDNE4S <br />GIIY <br />nY rnVnc LlbKnic• <br />O LI J`icarJua <br />1 <br />ME HANICAL CONTRAC OR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE 0 <br />PLUM�/B�""O//C�ONTRACTO/H <br />MAIL ADDRESS <br />CIE.EY1� <br />ZIP PHONE LICENSE F <br />//�CliI rtl,57Q4 If, <br />l'�5.5 kJ A4/-/u <br />j <br />u --w I <br />9&r/Jo5' 74733/1 Jlia/yilE37� <br />LFFOF WORK <br />NEW ❑ ADDITION <br />❑ ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ <br />WOODSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THESAMETO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF 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 CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGIIA',UREOF NT CTOR OR AUTHORIZED AGENT DATE <br />yK_ n <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH'OUR COPIESI <br />LOT—BLOCK_0 <br />PROJECT ADDRESS ' /(' <br />J <br />APPLICANT' CITy� E�ICENS O <br />Gt/ <br />PLUMBING <br />MECHANICAL <br />O. <br />_ <br />TYPE OF FIXTURE <br />FE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSE T I TOILETI <br />AIR COND UNITS-H P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />40 <br />LAVATORY IWASH BASINI <br />BOILERS—H.P. EA <br />_ <br />SHOWER <br />OAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITC14EN SINK& DISP. <br />FORCED AIR SYSTEMS—B.T.U. MEAL. <br />DISHWASHER <br />WALL HEATERS-8.7 U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />�� <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />Eff <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE —BAR, ETC.) <br />L1D <br />WOODSTOVE/FIREPLACE INSERT <br />u <br />eJ <br />SUB TOTAL <br />SUB TOTAL t <br />(/ <br />PERMIT t <br />PERMIT t <br />TOTAL FEE <br />TOTAL FEE t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />