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brc Evcrgrecn <br /> CITYOF CONSTRUCTION everett <br /> everett PERMIT <br /> rir�wu 15�eess <br /> tv[Ftti.wnsHincraN <br /> ve�ai <br /> °"` °"""':°""` BUILDING MECHANICAL PLUMBING <br /> oevuana[xr <br /> OWNEfl MAIL ADDRE55 ZIP PMONE <br /> L". � St89 Att3aai�t�a �0'! �lZ���, <br /> AFCMITECT OR OESIGNER MAIL A�DRE55 PHONE LICENSE NO. � <br /> � <br /> i� <br /> GENERALCONTRAGTOR MAI�qODRESS PMONE LICENSENO. ( <br /> 1 <br /> MECHANICAL CONTRACTOfl ^_ MAIL ADOROSS PHONE LICENSE NO. <br /> PLUM�ONTq.�CTOR w• �AO�SS� �ON� LI�E NO. <br /> W {�� <br /> PERMIT CLASS OF WORK � !j <br /> z <br /> ❑BUIIDING �PLUMBING �MECHAtJICAL F- <br /> ❑NEW — ❑ADDI'�ION ❑ALTERATION ❑RCPAIR � <br /> VALVATION OF WOflK � <br /> 5 ❑�EMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL � <br /> DESCRIU[WORK <br /> 073 <br /> PqOPOSED USE MECHANICAI. <br /> TVPFOFFVEL �OIL �N�1T. �LPG. �ELEC. <br /> L@GAL�ESCFIPTION OF PqOPERTV ISHOW�BLOW OR ATTACN GAS <br /> FOUF COPIES) <br /> LOT BLOCK_OF <br /> NO. NPC OF EQUIPMEN7 FEE <br /> AIR CONO. UNITS-H.P. EA. 5 I <br /> REFRIGERATION UNITS-H.P. EA. <br /> �OILERS-HA EA. � <br /> GAS FIRED A.C. UNITS-TONNAGE EA. <br /> FORCED AIP SVSTEMS-B.T.V. M EA. I <br /> JOB AODRESS� WALI HEATERS-6.T.U. M <br /> �YM+ <br /> UNIT HEATERS-B.T.U. M I <br /> PLUMBING EVAPORATIVECOOLERS <br /> CLOTHES�RVERS I <br /> VENTILATION FAN <br /> FANGEHOOD I <br /> NO. TVPE OF FIXTURE OR ITEM FEE P.IR HANDLING UNI i- QF.M. <br /> WATER CLOSETITOILET) 5 INCINERA OR � <br /> BATHTU� <br /> LA��ATORV(WASH BASIN) I <br /> SHON'EF <br /> J <br /> KITCIiEN SINK R DISP. SUU TOTAL Si � <br /> OISHWASNER PERMIT 5 V <br /> IAUNDFVTRAV TOTALFEE 5 <br /> CLOTHES WASHER THIS A[R�iIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br /> Wl�TER HEAT[R TION IIUTFIORIZED IS NOT COMMENCED WITHIN 720 Ol�VS, OR IF <br /> URINAL CONSTfiUCTION GR WORK IS SUSPENDED OR A�ANDONED FOR A <br /> ORINKING FOUNTAIN PERIOD OF 1?0 OAVS AT ANY TIME A�TER WORK IS CVMMENCED. <br /> FLOOR-SINK OR DfiAIN I HEREdV CERTIFY TI/AT I HAVE REAO AND C%AMIMEO THIS AP- <br /> VACVUM OREAKEFS PLICATION ANO KNOW THE SAME TO OE TRUE AND CORFECT. ALl <br /> ROOF DRAINS-RAINLEADERS PROVISIONS OP LAWS l�ND OflDINANCES GCVERNING THIS TVPE <br /> OF WORK WILL �E COMPLIED WITH N!HETHER SPEfIFIEO HEREIN <br /> SINK ISERVICE-�AR,ETC.1 OF NOT, THE GRANTING OF A PERMIT DOE; NOT PRESUME TO <br /> GIVE AUTHORITV TO VIOLATE OR CANCEL TH@ FHOV�FIONS OF <br /> ANV OTHER STATE OR LOCAL LAW REGULAI�ING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTFUCTION. <br /> SVBTOTAL <br /> PERMIT 5 <br /> TOTALFEE 5 <br /> X ' <br /> SIGNATUREOFCONTRACTORORAUTH.AGENT DA'iE <br /> SIOEYARDSETOACK 5TliEETSET�ACK REARV:�RDSET6ACKPLANCHECKNUhiF3ER PLANCHECKFEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> ❑vEs ONo FEES VALUATION FEE <br /> TVPE OF CONST. OCCUPANCV GROUP UNIOS DWELLING I <br /> —1 <br /> SI2E OF HLOG. NO.OF STORIES MA%.00C. IOAD OUILOING 5 � <br /> I <br /> —�__ <br /> PlUMOING � <br /> FIRE 20NE �ASEM[NT FIRESPFiINKLERS I <br /> flEDUIREO �I <br /> ❑VES ❑NO MECHA�LCAL �� <br /> SPECIAL CONDITIONS: OTHER � <br /> f'ENE�TY SEC.3031a) I <br /> TOTAL 'j j(� <br /> PERMIT VALIUATION <br /> WH[N PROPEfiLV VALIDATEO UN THIS SPI�CEI THIS IS VOUR�ERh11T <br /> PIY'l'L�TIONACCCPi[OOY: �LAN50�[CKE�pY'. 4PPPOVfDlON65UPNCEOY�. <br /> �3�. a.0♦ <br /> a , <br />