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the Evergreen <br />CITY OF <br />eve rett <br />CITY HALL 259dAA5 <br />EVERETT, IVASHINGTON <br />992UT <br />DEFT OF COMMUNITY BUILDING <br />DEVELOPMENT <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />evereti <br />PLUMBING ,e <br />G'NA:CER �R�M� g�lI�yyE�� �MIAAIL�ADDRESS ZIP PHONE <br />#at � 0"40 JAPE) am <br />..TPt[ <br />�wiV <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />i O <br />11019 <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />m <br />5 <br />PERMIT <br />❑BUILDING ❑PLUMBING MECHANICAL <br />CLASS OF WORK <br />MEW ❑ADDITION [I ALTERATION ❑REPAIR <br />� <br />Z <br />~ <br />VALUATION OF WORK <br />$ <br />❑DEMOLISH []FENCE ❑SIGN ❑SWIMMING POOL <br />CC <br />LU <br />D ESC RISE WORK <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL ❑OIL ❑NAT. ❑LPG. _❑ELEC. <br />GAS <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT .-OCK_OF <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-M.P. EA. <br />S I <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />_ <br />I <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />_ <br />FORCED AIR SYSTEMS-B.T.V. M EA. <br />I <br />JOB ADDRESS 3W MR <br />WALL HEATERS-B.T.U. M <br />— I <br />UNIT HEATERS-B.T.U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />—I <br />' <br />VENTILATION FAN <br />RANGEHOOD <br />I <br />AIH HANDLING UNIT- C.F.M. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />- <br />WATER CLOSET (TOILET) <br />BATHTUB <br />$ <br />INCINERATOR <br />I <br />LAVATORY (WASH BASIN) <br />I <br />SHOWER <br />KITCHEN SINK & DISP, <br />SUBTOTAL $ <br />DISHWASHER <br />PERMIT $ <br />LAUNDRY TRAY <br />TOTALFEE $ <br />1 <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTH0 RIZED 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 TYPL <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 />it <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUMBREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />_ <br />PERMIT <br />S <br />TOTALFEE <br />S <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />510E YARDSETBACK <br />tl.SL 2ONF <br />STREETSETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />LOT AREA <br />VACANTSITE <br />❑YES ❑NO _ <br />FEES <br />VALUATION <br />FEE <br />TYt'E OI CONST. <br />SIZE OF HLOG. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />1 <br />BUILDING <br />$ <br />I <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />1 <br />IaNE <br />Ff9! l <br />BASEMENT <br />FIRE LERS <br />REQUIRED <br />❑VES ONO <br />MECHANICAL <br />OTHER <br />SPECIAL CONDITIONS: <br />PENELTY <br />SEC. 300(o) <br />I <br />--- <br />TOTAL <br />j <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT <br />0 <br />APPLICATION ACCEPTED BY: <br />PLAITS CHECKED BY APPROVED <br />FOR ISSUANCE BY: <br />lace <br />