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the Evergreen <br />CITY OF <br />everett <br />CITY HALL J598t15 <br />EVERETT, WASHINDTON <br />"n; <br />DEFT. OF COMMUNITY BUILDING <br />DEVELOPMENT <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />evere" <br />PLUMBING �.e <br />OWNER MAIL ADDRESS ZIP PlIONL <br />C= OF E IMI <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR �w.MAIAI�L ADDRESS PHONE LICENSE NO. <br />t" � ty 391* TTOVR <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />cc <br />W <br />[D <br />PERMIT <br />[ifVILDING ❑PLUMBING ❑MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑AITERgTION [WEPA1R <br />Z <br />F <br />VALUATION OF W�ORK�/�LLacc <br />S (� <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />LU <br />Q_ <br />DESCRIBE WORK <br />ClAw w 3%01 11Mm <br />1590 <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY ;SHOW BELOW OR ATTACH <br />FOUR COPIES( <br />LOT BLOCK —OF <br />TYPE OF FUEL ❑OIL ❑NAT. ❑LPG. ❑ELEC. <br />GAS <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.V. M EA. <br />I <br />JOB ADDRESS w <br />tmr, Awe <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 />Ir- <br />WATER CLOSE I(TOILET) <br />g <br />INCINERATOR <br />I <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I <br />SHOWER <br />KITCHEN SINK & DISP. <br />SUBTOTAL $ <br />DISHWASHER <br />PERMIT $ <br />LAUNDRY TRAY <br />TOTALFEE $ <br />CLOTHES WASHER <br />WATER HEATER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <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 AU T'.1UKIIY TO VIOLATE OR CANCEL THE PROVISIONS Or - <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />x <br />_ <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL <br />PERMIT <br />$ <br />TOTAL FEE <br />$ <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREETSETBACK <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 />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />I <br />BUILDING <br />$ <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />I <br />FIRE ONE <br />BASEMENT <br />LERS <br />RFOUI <br />Rf OVIREDED <br />OYES ONO <br />MECHANICAL <br />OTHER <br />I <br />SPECIAL CONDITIONS: <br />I <br />- ----- -- <br />— - -- <br />PENELTY <br />SEC. 000 (a) <br />I <br />TOTAL <br />OD <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />a <br />APPLICATION ACCEPTED 9Y'. <br />PLAHS CHELKFD BY: APPnOVCD <br />fOH ISSUNSC BY <br />La <br />