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EVERETT. WASHINGTON <br />95101 <br />DEPT. OF COMMUNITY <br />BUILDING MECHANICAL PLUMBING <br />DEVELOPMENT EIOPMEN <br />OWNER MAIL ADDRESS ZIP PHONE <br />me <br />rr <br />i <br />ARCHITECT OR DESIGNLR MAIL ADDRESS PHONE LICENSE NO. <br />GENE RAL CONT RACTOfl MAIL ADDRESS PHONE LICENSE NOlgklg . <br />j$y oDRES j �y �P itF Fn LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />m <br />PERMIT <br />1y..� <br />❑ BUILDING ❑ PLUMBING �I MECHANICAL <br />CLASS OF WORK <br />Iy NEW [:]ADDITION ❑ALTERATION ❑REPAIR <br />z <br />F_ <br />2 <br />VALUATION OF WORK <br />$ <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />cc <br />LU <br />DESC131BE WORK .�+�p�:�* <br />i+a3= 2 CAS ...a lon <br />(� %Q <br />V t V <br />PROPOSED USE <br />MECHANICAL <br />TYPEOFFUEL ❑OIL ❑NAT. ❑LPG. ❑ELEC. <br />GAS <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 />$ I <br />REFRIGERATION UNITS-H.P. EA, <br />BOILERS-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 y. <br />vmlmw �8r <br />WALL HEATERS-B.T.U. M <br />UNIT'HEATERS-B.T.U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGE HOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />WATER CLOSET (TOILET) <br />$ <br />INCINERATOR <br />I <br />BATHTUB <br />'r <br />LAVATORY (WASH BASIN) <br />I <br />SHOWER <br />KITCHEN SINK & DISP. <br />SUBTOTAL $ <br />I <br />DISHWASHER <br />PERMIT <br />LAUNDRY TRAY <br />TOTAL FEE $ <br />I <br />CLOTHES WASHER <br />�— <br />WATER HEATER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTfl UC. <br />TION AUTHORIZED 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 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 <br />URINAL <br />_ <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS -RAIN LEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />$ <br />TOTALFEE <br />$ <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />T Y'PE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />I <br />BUILDING <br />$ <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />I <br />I <br />FIRE ZONE <br />BASEMENT <br />REQUIRED KLERS <br />DYES ONO <br />MECHANICAL <br />90. <br />SPECIE nONDITIJNS: <br />OTHER <br />PENELTY <br />SEC. 303 (a) <br />1 <br />- <br />TOTAL <br />2d so <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />APPLICATION ACACCEPTED BY: <br />�•!' !. <br />PLANS CHECKED BY: APPROVED <br />FOR ISSUANCE BY. <br />ut uw <br />