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the Evergreen <br />CITY OF <br />everett <br />CRY BAIL FSV UIS <br />[V[BETT. WSBINO[ON <br />SINI <br />DDT. OF COMMUNITY BUILDING <br />DEVELOPMENT <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING <br />uVFNI,H <br />a M <br />MAIL ADDRESS <br />ZIP PHONE <br />a 8 <br />;_::.rl <br />ARCHITETE CT OR DESIGNER <br />6 <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />CZ <br />Ul <br />0] <br />PERMIT <br />[BUILDING ❑ PLUMBING []MECHANICAL <br />CLASS OF WORK <br />[I NEW <br />❑ADDITION ❑ALTERATION ❑REPAIR <br />Z <br />� <br />VALUATION OF WORK <br />$ *ern r� <br />iF.A/BA <br />[I DEMOLISH <br />FENCE ❑SIGN ❑SWIMMING POOL <br />LLI <br />Q. <br />DESCRIBE WORK <br />IXT nr ;<r pin TAys <br />2574 <br />PROPOSED USE' <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH <br />FO IESI —Al—LOOTURCBLOCKOF ME= PAM <br />TYPE OF FUEL []OIL ❑NAT. ❑LPG. ❑ELEC. <br />GAS <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AT COND. UNITS- H.P. EA. <br />$ 1 <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />I <br />JOB ADDRESS D7M � <br />"" '" �r4m=y �� �' <br />PLUMBING <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />EVAPORATIVE COOLERS <br />1 <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR DANDLING UNIT— C.F.M. <br />WATER CLOSET ITOI LET) <br />y <br />INCINERATOR <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISP. <br />SUBTOTAL S <br />1 <br />DISHWASHER <br />PERMIT S <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />TOTAL FEE $ <br />WATER HEATER <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 />PERIOD OF 12C DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CCRTIFY 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 />x rh9�i <br />SIGNATURE OF CONTRACTOR OR AUTH.AGENT DATE�-�- <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR —SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR ETC.) <br />SUBTOTAL <br />PERMIT $ <br />TOTAL FEE $ <br />SIDEYARDSETBACK <br />STREETSETBACK <br />REARYARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />SIZ2 OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />BUILDING <br />S 1/Vlbo <br />PLUMBING <br />FIRE ONE <br />BASEMENT <br />FIRE SPRINKLERS <br />RFOUIREO <br />❑YES ONO <br />MECHANICAL <br />SPECIAL CONDITIONS: <br />OTHER <br />L <br />1 <br />PENELTY <br />SEC. 000 (a) <br />I <br />TOTAL <br />�+ <br />7 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THISSPACE) THIS IS YOUR PERMIT <br />APPLICATIONACCEPTEDSY: <br />PUNSCHECKEDBY. <br />APPROVED FDA ISSUANCE BY <br />op <br />