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the Evergreen <br />CITY OF <br />everett <br />CITY HALL Z599915 <br />EVERETT, MATHINCTON <br />917111 <br />DEPT OF COMMUNITY BUILDING <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING �e <br />V MAIL ADDRESS ZIP PHONE <br />O W N E RJ �{yy�L��, <br />ow o � waboom "� <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />+ <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />M SE NO. <br />ECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICEN <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />•fN an NOWco <br />W <br />PERMIT CLASS <br />OF WORK <br />z <br />❑BUILDING PLUMBING ❑MECHANICAL <br />❑NEW Cl ADDITION ❑ALTERATION ❑REPAIR <br />F— <br />cc <br />VALUATION OF WORK <br />❑DEMOLISY. ❑FENCE ❑SIGN []SWIMMING POOL <br />LU <br />d <br />5 --- <br />D SC I RQ. i __ <br />335 <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL ❑OIL ❑GAS ❑ LPG. ❑ELEC. <br />LEGALDESCHIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />LOT BLOCK OF- <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S I <br />REFRIGERATION UNITS-H.P, EA. <br />BOILERS-H.P. EA. <br />1 <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-O.T.U. M EA. <br />1 <br />ADDRESS <br />WALL HEATERS-B.T.U. AllJ06 <br />B.T.U. AIRUNIT HEATERS - <br />1 <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNIT- C.F.M. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />INCINERATOR <br />WATER CLOSET ITOILET; <br />S <br />BATHTUB <br />I <br />LAVATORY (WASH BASIN) <br />SHOWER <br />SUBTOTAL $ <br />1 <br />KITCHEN SINK IL DISP. <br />DISHWASHER <br />LAUNDRY TRAY <br />PERMIT S <br />TOTAL fEE S <br />1 <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CO NSTRU C <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 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 WORWITH <br />OR NOTK HIE GRANTIINGBE COL OP A PERM TETHER FIED DOES NOT (PRESUME TTO <br />GIVE AUTHORITY TO OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCALELAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />7�/}+7C/171_N <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />w <br />{ <br />SUBTOTAL <br />I _ <br />$ <br />PERMIT <br />TOTAL FEE <br />S <br />SIGNATURE OF CONTRACTOR OR AUl H. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES []NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITOS OWE LLING <br />I <br />BUILDING <br />S <br />1 <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />1OD <br />PLUMBING <br />FIREZONE <br />BASEMENT <br />FIRESPRINKLERS <br />REQUIRED FS []NO <br />MECHANICAL <br />I <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />1 <br />PENE LTY <br />SEC. 3031a) <br />TOTAL <br />�Ioo <br />- <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE( THIS IS YOUR PERMIT <br />APPLIGT�IN CEPTEO BY: PUNSWECKEDEPY, APPROV= ANCE BY. <br />0 <br />