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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 859898S <br />EVERETT, WASHI%GTBN <br />9890I <br />BEPT OF COMMUNITY BUILDING <br />BEVELOPMENI <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING �e <br />OWNER MAIL ADDRESS ZIP PHONE <br />7 <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />. " A'i Z M"- AlJ <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />cr <br />LU <br />ED <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />© BUILDING ❑ PLVMBING ❑ MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />� <br />z <br />VALUATION OF WORK <br />$ 1rMy� <br />it 406 <br />❑DEMOLISH ❑FENCE IJGIGN ❑SWIMMING POOL <br />W <br />Q. <br />DESCRIBE WORK _ <br />a Q! P F F, '7"__ - A <br />Af� <br />22�05 <br />PROPOSED USE <br />MECHANICAL <br />TYPE <br />OF FUEL ❑OIL ❑GAS. ❑LPG. ❑ <br />E1. EC. <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 COND. UNITS—H.P. EA. <br />$ 1 <br />qEf-R IGERATION UNITS—H.P. EA. <br />BOILERS—H.P. EA. <br />I <br />JDR ADDRESS <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />I <br />WALL HEATERS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />1 <br />_ <br />EVAPORATIVE COOLERS <br />PLUMBING <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 />INCINERATOR <br />---------- <br />WATER CLOSET(TOILETI <br />$ <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP. <br />SUB TOTAL $ <br />1 <br />DISHWASHER <br />PERMIT $ <br />LAUNDRY TRAY <br />TOTAL FEE $ <br />I <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRI C' <br />TION '1UTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME YO 3E 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 />�( Li/'1r"? <br />WATER HEATER <br />URINAL. <br />DRINKING FOUNTAIN <br />FLOOR —SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />$ <br />TOTAL FEE <br />$ <br />SIGNATUREOF C ONTRACTORORAUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITS DWELLING <br />BUILDING <br />$ UM000 <br />Gj(p <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />I <br />FIRE ZONE <br />BASEMENT <br />FIRELEgS <br />RED <br />REQUIRED <br />DYES ❑NO <br />MECHANICAL <br />I <br />SPEL:IAL CONDITIONS: <br />OTHER <br />I <br />- <br />PENELTY <br />SEC. 303 (R) <br />TOTAL <br />_1 <br />Fj I I� <br />a <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS N..'. III PERMIT <br />0 <br />AMLICATION ACCEPTED By <br />[LANSClItCKED BY <br />A%'ROVEOyOh155UANCE BY. <br />