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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 2598895 <br />EVERETT. WAS14INGTON <br />98201 <br />OFPT.°DEVE MUNITY <br />OPMENT BUILDING <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />OWNER yry�� MAIL ADDRESS ZIP PHONE I <br />� �•.` L,� LF�. a':Qil T..4'JL: .,Lp�e�l <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />n <br />MECHANICAL CON TRAC 70R MAIL ADDRESS PHONE LICENSENO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Q• <br />LU <br />(YI <br />PERMIT <br />p BUILDING ❑ PLUMBING ❑ MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />z <br />~ <br />VALUATION OF WORK <br />51 <br />El DEMOLISH ❑FENCE ]SIGN ❑SWIMMING POOL <br />CL <br />W <br />d <br />DESCRIBE WORK <br />1 w{. <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK?--IF"AM bX123 3T4 � • <br />TYPE OF FUEL COIL ❑NAT. ❑LPG. ❑ELEC.GAS <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />$ <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 />JOB ADDRESS <br />`�"ll= <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />EVAPORATIVE COOLERS <br />I <br />PLUMBING <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 />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK Be DISP. <br />SUB TOTAL $ <br />I <br />DISHWASHER <br />PERMIT $ <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />TOTALFEE S <br />I <br />WATER HEATER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />TION AUTHORIZED 15 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 />1 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 />ff <br />x-7V <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 />SIGNATUREOFCONTR ACTOR OR AUTH. AGENT DATE <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />SIDE Y�RDSETBACK <br />STREET4 ETBACK <br />L <br />REAR YARDSETBAC <br />20 <br />USE ZONE <br />w1 <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TY E OF ONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX.00C.LOAD <br />BUILDING <br />$ lloom <br />5100 <br />PLUMBING <br />I <br />1 <br />FIRE ZONE <br />BASEMENT FIRESPRINKLERS <br />REQUIRED <br />DYES ❑NO <br />MECHANICAL <br />I <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />---I <br />- <br />PENELTY <br />SEC. 303(a) <br />I <br />---- <br />TOTAL <br />a <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />3 <br />APPLICATION ACCEPTED BY: <br />PLANS CHECKED BY: APPROVED <br />FOR ISSUANCE BY. <br />