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the Evcrgicen <br /> CITV OF CANSTR UCTION everett <br /> everett PERMIT <br /> cirvnnu xs�aees <br /> FVEflEti,fYASNIHGTdN - <br /> �eim <br /> °`°` °`�°'"'°�"' BUII_DING MECHANICAL PLUMBING <br /> ncvcinvn�Exr <br /> OWNER R:AILADDRESS ZIP PHONyE �,� <br /> AR�TECT Ofl DESIGNER M�ADDR� �E L�NSE NO. a� <br /> GENERALCONTRACTOR MqILADDRE55 PHONE LICENSEIJO. <br /> � <br /> MECHANICALCONTRACTOR MAILADDRGSS PHONE LICENSENO. <br /> PLUMBING CONTRACTOR MAIL A�DRESS PHONE LIC:NSE NO. � <br /> W <br /> m <br /> PERMIT CLASS OF WOR1: � <br /> z <br /> �BUILDING � PLUMBING ❑MECI�IANICAL F- <br /> �NEW ❑ADDITION ❑ALTERATIpN ❑REPAIR � <br /> VALUATION OF WORK (t <br /> 5 ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL a <br /> DESCRIBE WORK <br /> O�aa� a�r a�a�e:e 0 7 4 <br /> PROPOSED USE MECHANICAL <br /> LEGAL DESCRIPTION OF PROPEFTV (SHOW EELOW OR ATTACH TYPE OF FUEL �OIL GGAS ❑LPG. �ELEC. <br /> FOVfi ES) <br /> LO7 � BLOCK—oF � � NO TVPE OF E�UIPMENT FEE <br /> AIR CONO. UNITS�-H.P. EA. $ i <br /> REFRIG[RATION UNITS-H.P. EA. <br /> BOILERS-H.P. EA. � <br /> GAS FIRED A�.Q UNITS-TO:VNAGE EA. <br /> FORCED AI(i SYSTEMi-6.T.U. M EA. I <br /> JOB ADDP S� � � W:LL NEATERS-B.T.U. M <br /> UNIT HEATERS-B.T.U. M I <br /> PLUMBING EVl�PORATIVE COOLEfiS <br /> CLOTNESDftVFRS I <br /> VENTILl�TION FAN <br /> RANGEHOOD I <br /> NO. TYPE OF FIXTURE OR ITEM FEE �+�R HANDLING UNIT- C.F.M. <br /> WATERCLOSETITOILET) g INGNEfiATOF I <br /> BATHTUB <br /> LAVATORY (WASH BASII�) I <br /> SHOWER <br /> KITCHEN SINK& DISR ~� SU�TOTAL 5 � <br /> DISHWASHER PERMIT 5 <br /> LPUNORV TRAV <br /> TOTAL FEE 5 � <br /> CLOTHES WASHER _ TIiIS PERMIT BECOMES NVLL AND VOID IF WORK OR CONSTRUC- <br /> WATER HEATER _ TION l�.UTHORIZED IS NOT COMMENCED VJITHIN 120 �AVS, OR IF <br /> URINAL CONSTRUCTION OR WOfiK IS SUSPENDED OR A6ANDONED FOR A <br /> ORINKING FOUNTAIN PERIOD OF 120 DAYS AT ANV TIME AFTER WORK IS COMMENCED. <br /> FLOOR-SINK OR ORAIN I HEREBV CERTIFV THAT I HAVE READ AND EXAMWEO THIS AP- <br /> VACUUM BREAKERS PLICATION AND KNOW THE SAME TO 6E TRUE AND CORRECT. ALL <br /> POOF DRAINS-FAINLEADEflS —I— ��OVISIONS OF LAWS ��ND ORDINI.NCES GOVERNING THIS TYPE <br /> OF WORK WILL BE CO�IPI.IEU WITN WHETHER SPECIFIED HEFEIN <br /> SINK (SEPVICE-BAR, ETC.) �— OR NOT, THE GIiANTIfJG OF A PEAMIT DOES NOT PRESVME TO <br /> GIVE I�UTNORITV TO VIOIATE Oq CANCLI THE PFiOVISIONS OF <br /> ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OF THE PERFORMANCF.OF CONSTRUCTION. <br /> SU6 TOTAL i <br /> PERN!r 5 <br /> TOTALFEE 5 <br /> x <br /> SIGNATUREOFCONTf1ACTORORAUTH.AGENT AT <br /> SIDE YARD SET6ACK STfiEET SET�.9CK REAR YAF�SET�ACK PLAN CHECK NUMBEFl PLAN CHECK FEE <br /> FEE HECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE �I <br /> ❑��� �N� FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF OWELLING <br /> UNITS I <br /> SIZE OF BLDG. NO.OF STOPIES MA%.00C. LOA� DUILDING � 5 �yR� ,�, � <br /> PLU�4BING � <br /> FIREZONE BASEMFNT FIRESPftINKLERS � <br /> RI:�UIRED I <br /> ❑VES ❑NO MECHANICAL � <br /> SPECIAI CONDITIONS: OTHER � <br /> — PENELTY SEC. 3031a) I <br /> — TOTAL � <br /> I <br /> � � PERMITVALIDATION <br /> - WHEN PqOPERLV VALIOATED(IN THIS SPACEI THIS IS VOUft PERMIT <br /> i __ <br /> I <br /> i.L�ini.nnnncr.trrti�uv ��u.ra:a�rr,rcmur. nrvnov[owNissunHceor <br /> ! Mti•r ff.M{�is �ti�'..• <br /> I � <br /> ..—"1 <br />