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the Evergreen <br />CITY OF <br />eve rett <br />CITY HALL 259 BUS <br />EVERE TT, WASHINGTON <br />9BNI <br />DEW. OF COMMUNITY BUILDING <br />OTWO PMENT <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING �e <br />OWNER MAIL ADDRESS ZIP PRONE <br />~ <br />ARCHITECT OR DESIGNER MAIL ADDRESS _ PHONE LICENSE NO. <br />GENERAL <br />�N �CONyTTRRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />i'Jfl. Ai• <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />m <br />PERMIT <br />BUILDING []PLUMBING ❑MECHANICAL <br />CLASS OF WORK <br />IO,�yyII <br />NEW ❑ADDITION [I ALTERATION ❑REPAIR <br />2 <br />z <br />h <br />VALUATION OF ��FLL��WORKN <br />$ V�v) <br />[I DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />CL <br />a <br />DESCRIBE WORK <br />art""'m9m :5= era, on Pr7v.AV 1"aWom <br />1983 <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL (JOIL ❑GAS ❑LPG. ❑ ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR CONES. UNITS-H.P. EA. <br />$ I <br />REFRIGERATION UNITS-H.P. EA. <br />BOIL ERS-H.P. EA. <br />I <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />I <br />JOB ADDRESS <br />WALL HEATERS-B.T.V. M <br />UNIT HEATERS-R.T.U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGE HOOD <br />I <br />AIR HANDLING UNIT- C.F.M. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET ITOILEII <br />BATHTUB <br />g <br />INCINERATOR <br />I <br />LAVATORY (WASH BASIN) <br />1 <br />SHOWER <br />KITCHEN SINK & DISP. <br />SUBTOTAL $ <br />_ <br />I <br />DISHWASHER <br />PERMIT $ <br />LAUNDRY TRAY <br />TOTALFEE $ <br />I <br />CLOI HES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC� <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />FERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT 1 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 COMPLIED WITH WHETHER SPECIFIED HEREIN <br />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 />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />_ <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS -RAIN, EADE RS <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL <br />PERMIT <br />$ <br />TOTAL FEE <br />$ <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YAROSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑YES [:]NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO.OF DWELLING <br />UNITS <br />I <br />BUILDING <br />$ i� <br />S IMry <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />1 <br />FIRE 20NE <br />BASEMENT <br />RINK LERS <br />REQUIRED <br />OYES ONO <br />MECHANICAL <br />1 <br />SPECIAL CONDITIONS: <br />OTHER <br />PENELTY <br />SEC. 303181 <br />1 <br />TOTAL <br />3 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />0 <br />AWLICATION ACCEPTED BY: <br />PLANSCHECKFDBY: APPROVED <br />FOP TZILIANCE BYIs <br />YPN <br />