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.,PPLICATION FONTL <br /> CITYor lAfffll <br /> Evergreenthe CONSTRUCTION <br /> CITY D <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INT:— PLEASE PRINT <br /> BUILDING DEPT. <br /> 2598745 ❑ COL'BINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAIL ADDRESS CITY ZIP PHONE <br /> James F. Templin 27 70th S.W. Everett 98203 353-4463 <br /> AnCIII If Ct ON DESILNfR MAIL ADDn"S CITY zip PHONE <br /> tit NI RAI C0141PACION MAIL ADDRESS CITY IIP PHONE LICENSE. <br /> ELerett Bldrs. Inc. 5606 Everpreen Way Everett 98203 353-7161 <br /> MECIIANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br /> (EV-FR-EB-*3-llL3) <br /> 1'LUMUIN(L CUNIFMCTUII MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> CI ASS OF WOR. <br /> ❑ NEW ❑ ADDITION C'yM ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILUWG PELOCATION <br /> VALUATION O'WORK ICOST OF MATERIALS PLUS LABORI <br /> 11,667.00 <br /> IIIS(:1IFF WORK <br /> Kitchen remodel, clock and install hot tub <br /> USI Or BuRnINu <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 /> Lf UAT DESCRIPTION OF PROPERIYISDOWN ALLOW OR ATTACH FOUR CONTEST PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br /> 6 O'Oonnor and cronin's OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> lor_ntocK_Gr IN OR NOT.THE GRANTING OF A PERMITDOES 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 /> SIGNATURE CONTRACTOR AUTHORIZED AGENT DATE <br /> xU <br /> PRORC1 ATIRIESS APPLICANTS Cl YBU91 99 LIC[N9EN <br /> 27 76th\S.W. Everett, Wa. 98203 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NC TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILE AIR COND.UNITS-H.P.EA <br /> _ BATHTUB REFRIGERATION UNITS-H.P.EA _ <br /> LAVATORYIWASH BASIN) BOILERS-H.P.EA <br /> —7 SHOWER OAS FIRED AC.UNITS-TONNAGE EA _ <br /> KIfc S OC FORCED AIR SYSTEMS-6 T.U. MEA. <br /> DISHWASIIER Z2& WALL HEATERS-B.T.U. M <br /> LAUNDRYIAAY UNIT HEATERS-B.T.U. M <br /> _ CLOTHES WASHER _ EVAPORATIVE COOLERS _ <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN _ <br /> DRINKING FOUNTAIN RANGE HOOD <br /> _ FLOOR DRAIN AIR HANDLING UNIT- CT.M _ <br /> VACUUM BREAKERS_ _ STOVE <br /> _ROOF DRAINS-RAINLLADERS METAL FIREPLACE&CHIMNEY <br /> SINK SERVICE-80,111,ETC.I WOODSTOVEIFIREPLACE INSERT <br /> hot tub <br /> _ SUB TOTAL _ _ C BUB TOTAL B _ <br /> _ <br /> PERMIT E PERMIT <br /> TOTALITIES E TOTAL FEE <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> I PONT SETBACK At All BE IBACN SIDE SETBACK PLAN CHECK NUMBER )CPI AN CHECK FEE <br /> �.^1 E AREA <br /> J Icen, ]J 0/0 FEE 617" AEC[IPI Np�_ <br /> 116[ZONE VV/np LOT AO[A ,VACANT S E a l)FEE ..ZL- <br /> fjpO fx OYES 0 FEES VALUATION F!! _- <br /> IYPtOFCONST OCCUPANCY GROUP NO.OF DWELLING UNITS <br /> V io <br /> I�- V 1 BUILDING <br /> SHE OT RLUU NO Of STORIES MAX OCG LOAD -- -' <br /> PLUMBING _15- 00 <br /> MECHANICAL <br /> FIRE SPRINKLERS REQUIRED ❑YES O NO <br /> OIIIEA <br /> PENALTY <br /> APPUCAIIONACC AT PLANSCNECKEDBY APPA.FOR ISSUANCE BY <br /> TOTAL <br />