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,�PPLICATION FO� <br />tAe Everpreen C O N S T R U C T f O N <br />cin or <br />everett PERMIT <br />BUILDING DEPT. <br />259-8745 <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />everetl <br />e <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING �.SIGN <br />GENEFAICONTRAL70fl MAILADDFE55 CI7Y ZIP PMONE LICLNSE• <br />r>..� �„ .�-.. �-r.,,. L�T c�,.., �7�v / y�i�n,:N.,n �I4o4l� �77G -8Y3s— J��RRy �IiN.�y�LO <br />CONTRACTOq <br />CI1V <br />LICENSE � <br />PLUMBINGCONTRACTOR MAILAODRE55 CITY 21P PHONE LICENSE• <br />CLP55 OF WUNn <br />�NEW I,�`ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINGRELOCATION <br />�LUATION OF W7PK �COSTOF MFTERIRLS PLUS LABOR) <br />34�7$ "' <br />OESCRIBE WORN <br />O._. ..,.- �.,,�,,,� �i._�� w.ln Ann df�,�, 3�R' nF �LLlI1�uVh�.� S/c�J <br />LpT�BLOLK— <br />V � <br />NO. <br />FflONT SETBACK <br />CONST. <br />512E OF 9LOG. <br />�,-L/�'FE'�Yt�`�"G�it� C..il�'v <br />TYPE GF <br />HEATER <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR �10T. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATl1RE OF CONTRACTOR OR AUTMOFIZEO AGENT OATE <br />����� %�� - - .ci� �$� <br />eani i�nuTS, V 61151NESS LIGENSE N0. <br />MECHANICAL <br />N0. TYPEOFEOUIPMEN <br />AIR COND. UNITS—H.P. EA. <br />REFRIGERATION UNITS—H.P. E0. <br />BOILERS—H.P. EA. <br />GAS FIRED AC. UNITS—TONNAGE <br />fORCED AIR SVSTEMS—B.T.U. M <br />WALL HEATERS—B.T.U. M <br />UNITHEATERS—B.T.U. M <br />f-VAPORATIVE COOLERS <br />ClO7HESDRYERS <br />VCNTILATION FAN <br />RRNGEHOOD <br />AIH HANDLING UNIT— C.F.M. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBFCK <br />LOTAREA <br />OCGUPHNGVGFOUP <br />N0. OF 51'ORIES <br />:RS RE�l11RED ❑ YES � <br />BY PLANSCNECNE�DY <br />VACANT SITE <br />OYES ONO <br />NO.OF DWELUNG UNIiS <br />LOFD <br />�AN CNECK NUAIBER PLAN CHECK FEE <br />FEE iIECEiPiNO. <br />FEES VALUATION �EE <br />BUILOING 5 <br />PLUMBING <br />MECNANICAL <br />OTHER _ <br />PENAITY <br />FOR ISSU/ NGE BY <br />C�'�qC � TOTAL <br />�c4,C� `r-U <br />����o� <br />�j� ��LL �� <br />����t�' <br />'! <br />