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EAP Evergreen APPLICATION F O.< <br />CITY OF CONSTRUCTION <br />everett PERMIT e <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br />DWNFR MAIL AOORESB CITY ZIP PHONE <br />6 p r / �iAl Z�t'ft 70 � 90 Yel S�° Ey cP��- P6aoCr <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />_.,. _.......__-__......._..... ..._.-..__..___ ..... .. rnvnc LICENSE. <br />Lll /J6,1�-dZ- <br />PLUMBING ONTRAC OR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORN mRJ1I <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION 101 WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR, <br />DESCRIBE WORK // <br />/_ n eTn // ///An../C%n 11v An.✓ flA' n..� <br />USE OF BUILDING <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 />PROVISIONS OF LAWS AND 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT_BLOCr_OF <br />98aod <br />70S 9C 54 S F. ` ,� r 7T— � f//v. <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />_ <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY JWASH BAST <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK t DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS-B.T.0 M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />I <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR. ETC I <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL t <br />-- <br />PERMIT t <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEF f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FEE I RECEIPT NO <br />CIVES ONO T SITE <br />FEES VALUATION PEE <br />OYEB _ - <br />OCCUPANCYGROUP <br />BUILDING S <br />ROD NO OF STORIES MAIL OCG LOAD <br />PLUMBING <br />MECHANICAL <br />IRINKLERS REQUIRED ❑ YES O NO <br />OTHER <br />PENALTY <br />ION ACC BY PLANS CHEC (ED BY APPR FOP ISSUANCE BY <br />TOTAL loc <br />