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the fvergreen <br /> CITY OF CONSTRUCTION everett <br /> eve rett PERMIT <br /> cnrxnu esveaes <br /> [VEP[ii,WASNiNGICN <br /> 9L1a1 <br /> °E°� °°°°M„°�^� gUILDING MECHANICAL PLUMBING <br /> o[v[iovuExr <br /> OWNER MAILl�D�R[SS ZIP PI10NE <br /> T:ie �'ns:� �,�vara 1092-77 <br /> ARCHITECT OR DESIGNER MAIL ADDflESS PHONF L�CENSE NO. <br /> GENERALCONTRACTOP. MAILADDRESS PHONE LIGENSENO. <br /> xvere:t ,iyn Comhany <br /> MECHANICALCONTRAGTOR MAIL ADDIiESS ' PHONE LICENSE NO. <br /> PLUMOING CONTRACTOR MAIL ADDRE55 PHONE LICENSE NO. � <br /> W <br /> m <br /> PERMIT CLASS OF WORK � <br /> Z <br /> ❑BUILOING ❑ PLUMBING �MECHANICAL �NEW ❑ADDITION ❑ALTERATION ❑FEPA�R ~ <br /> VALVATION OF WORK � <br /> S lj'J�!yQ ❑DEMOLISH ��ENCE ❑SIGN ❑SWIMMING POOL a <br /> DESCRIBF WOHK <br /> :Xiubla PBCw Plro�aei•1-iv aiq:e 250.3 <br /> PROPOSED USE MECHANICAL <br /> IEGAL DESCPIPTION OF PROPERTV ISHOW BELOW OR ATT/1CH TYPE OF FUEL �DIL �u!�S. �LPG. �ELEC. <br /> FO V R COPI E51 <br /> Lo7 BLOCK—oF NO. TVPEOFEUUIPMENT FEE <br /> AIR CONO. UNITS-H.P. EA. S I <br /> REFRIGERATION VNITS-M.P. EA. <br /> �OILERS-Ii.P. EA. I <br /> GAS FIRED A.C.UNITS-TONNAGE EA. <br /> FORCED AIR SVSTEMS-B.T.V. M EA. 1 <br /> JOBQ.D 4F 55 WALL HEATERS-B.T.U. M <br /> 1�1 fiRX�tt' 1��nu� UNIT NEATERS-O.T.U. M 1 <br /> EVAPORATIVECOOLERS <br /> PLUMBING CLOTHESDRVERS 1 <br /> VENTILATIONFAN <br /> RANGEHOOD 1 <br /> NO. TYPE OF FIXTURE OR ITEM FEE ��R HANDLINc UNI7- c.F.M. <br /> WATER CLOSETITOILET) § �NCINERATOR 1 <br /> HATHTUB <br /> LAVATORVIWASHBASIN) � <br /> SMOWER <br /> KITCHEN SINK b DISP. SUB TOTAL 5 � <br /> DISMWASHEP PERMIT S <br /> LAUNDRY TflAV TOTALFEE 5 <br /> 1 <br /> CLOTHES WASHEH THIS PEHMIT �ECOMES NULL AND VOID IF WpRK OH CONSTRUC� <br /> WATER HEATER TION AUTHORI2ED IS NOT COMMENCED WITHIN 120 �AVS, OR IF <br /> URINAL CONSTHUCTION OR WOHK IS SUSPENDED OR A9ANDONED FOR A <br /> DRINKING FOUNTAIN �ERIOD OF 12� DAVS AT ANV TIME AFTER WORK ISCOMMENCEO. <br /> FLOOF-SINK OR DRAIN � HEREBV CERTIFV TIIAT I MAVE PEAO ANO E%AMINED THIS AP- <br /> VACUUM BREAKERS PLICATION ANO KNO\N THE SAME TO DE TRUE AND CORRECT. ALL <br /> PROVISIOYS OF LAWS AND OFDINANCES GOVERNING TI115 TVPE <br /> ROOF DRAINS-RAINLEADERS OF WORK WILL BE COMPLIEO W�TH WHETHEfl SPECIFIE� HEREIN <br /> SINK (SENVICE-BAR,ETC.1 OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANV OTNER STATE OH LOCAL LAW REGULATING CONSTRUCTION <br /> OR TIIE PERFOFMANCE OF CONSTRUCTION. <br /> SUBTOTAL <br /> PERMIT $ <br /> TOTAL FEE $ �/1�J/7�J <br /> x <br /> SIGNATUPEOFCONTRACTORORAUTH.AGENT �ATE <br /> SIDE VARO SETUACK STREET SETBACK REAR VARDSETBAC PLAN CHECK NUMBER PLAN CFIECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> ❑YES ❑No FEES VALUATION FEE <br /> TVPE OF CONST. OCCUPANCV GROUP UNITS DWELLING I <br /> SIZE OF �LDG. NO.OF SiOR1E5 MAX.00C. LOA� BUILOING 5 J � � <br /> I <br /> PLUMOING � <br /> FIRE20NE E3FSEMENT FIRESPFi1NKLERS <br /> REOUIREO MECHADlICAL 1 <br /> ❑VES ❑NO <br /> SPECIAL CONDITIONS: OTHER � <br /> 1 <br /> PENELTV SEC.90�1a1 � <br /> TOTAL +� <br /> I <br /> � PEHMIT VALIDATION <br /> WHEN PROPERIY VALIDATED IIN TMIS SPACE)THIS IS VOUR PERMIT <br /> AM'IICAiIONPCCEI'iCOBY: PLANSCMKFEDBV: AVFf10VEDFOPISSUFNCLBV. <br /> � <br />