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the Evcrgrcen <br />cirv or <br />everett <br />GiYNALI i59Btl81 <br />[V(N[li, N45111NIi1lIN <br />9ffipl <br />°`�' °` `°""°""� gUILDING <br />nweiorn¢xr <br />CONSTRUGTION <br />PERMIT <br />MECHANICAL PLUMBING <br />eVECQ� <br />OWNER �iAl�_ AOURESS ZIP PHONE <br />•�:�-�13=.� � ��-_��.:r ;5n'��75 a�?..�6 <br />ARCMTECT OR DESIGNFfi MAIL ADDRESS PHONE LICENSG NO. <br />GENERALCONTRACTOR MAILAODRES:: •[� PHOfvE LICENSENO. <br />��5.^� `• . i!.:.� ��� i�� '�n =����� w✓,'� '�}nj ,.Yr�r� y�t n�M <br />� l�I�YS,1.t;7 <br />MECHqNICAL CONTRACTOR MAIL AOCqESS PHONE LICENSE NO. <br />PWME3ING CONTRACTOR MAR ADDRE55 PHONE UCENSE NO. � <br />W <br />m <br />PERMIT CLASSOF WORK � <br />� <br />Z <br />�BUILOING �PLUM6�NG �MECHANICAL F <br />— ❑NEW --❑AODffION ❑ALTEflATION ❑RBPAIH � <br />VALUATIOryN yO�f- W�yO�RK <br />S 4V�MN ❑DEMOLISH [�ENCE ❑SIGN ❑SWIM1IMING POOI a <br />DESCPIB[ WORK .oY.,/"� � •},.••.,+ „•-� ��•. �y . . �1 G�'1 <br />r, . : -:_ayA �h-�i^, aiw �a�� '� �1�7 `'. �ii.i.; ..�.;w.......z, 101� <br />PROPOCEO U5� <br />. MECHANICAL <br />TYPE OF FUEL �OIL �NAT. �LPG. �E! EC. <br />LEGAL �ESCliIPTION OF PROPERTV ISHD6' �ELOW Ofi ATTACH GAS <br />FOUR � <br />LOT-_ I.00K � oF �"��'Y�`�'�'T NO. TVPEGFEOUIPMENT FEE <br />AIFi COND. UNITS-N.P. EA. 5 I <br />REFRIGERATION UNITS-H.P. EA. <br />— UOIlERS-H.P. GA. � <br />GAS FIfiED A.C. UNITS-TONNAGE EA. <br />FOliCED AIR SYS�EM115-B.T.U. M[A. I <br />JO� ADDRE55 s,���wny Sf WALL IiEATERS-D.T.U. M <br />`_I �'�������' r `�'��1� UNITHEATER�-3.T.V. M I <br />EVAPONATIVECOOLERS <br />PLUMBING CLOTHLS DRYEf15 I <br />VENTILATION �AN <br />RANGENOOD I <br />NO. TVPE OF FIX7URE OR ITEM FEE A�R HANDLING UNIT- C.F.M. <br />WATER CLOSETITOILETI g �NCIYEFIATOR ___ � <br />BATNTU9 <br />LAVATORV (WASH pA51N) —�— I <br />SHOWER <br />KITCHEN SINK t4 DISP. �— $UU TOTAL S � <br />OISHWASHCR PER�UT 5 <br />LnVNORVTliAY �_ TOTALFEE 5 I <br />CLOTHES WASHER +_ TIi15 PERMIT �ECOMES NULL AND VOIU IF'JOFK l�ti CONSTRUC- <br />WATER HEATER TION AUTHOqIZEO IS NOT COh1MENCED W:THIN 120 DAVS, OR IF <br />URINAI. CONSTRUCTION OR WOPK IS SUSPENDFD JR AI3ANOONED FOR A <br />DRINKING FOUNTAIN - PEFI00 OF 1Z0 �AYS AT ANY TIM17E AfTERIVORK IS COMMENCEO. <br />FLOOfl-SINK Ofl DRAIN I HEFEDY CERTIf'/ THAT I HAVE REAO ANO E%AMINED THIS AP- <br />VqCUUM �REAKERS PUCATION AND KIJOW TNE SAME TO 6E TRUE �1ND CORFECT. ALL <br />ROOF �RAINS-RAINLEADERS - P�OVISIONS OF LAWS AND OR�INANCES GOVERNING THIS TVPE <br />OF WORK WI�L OIE COA9PLIED WITH 1NHLTHER SPECIFIEO HEREIN <br />SINK (SERVICE-6AR. ETC.1 —t— OR NOT, TNE GR.�NTING OF A PERh11T OOES NOT Pf7ESUME TO <br />GIVE AUTHORITY TO VIOLATE OH CANCEL TH[ PROVISIONS OF <br />- ANv OTHER STATE O(i IOCAL LAIV REGULl�TING CONSTRUCTION <br />OF TNE PERFORMANCE OF CONSTRVCTION. <br />SU(i TOTAI_ <br />PcRM1T 5 <br />TOTAL FEE 5 � �p C,:�p y�� �i�t� <br />x <br />SIGNATUFEOFCC�NTR/1CTOFOFAUTM.AGENT OATE , <br />SIOE V�1RD SETOACK STFEET SET6ACK fiEAF Vl�R�'dETOACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE 20NE LOT AREA VACANT SITE <br />❑YES ❑NO FEES VALUATION FEE <br />TVPL OF CONST. OCCUPANCY GROUP NO.OF DWELLING <br />UNITS I <br />512E OF BLOG. NO. OF STOfiIES M1tA!(. OCC. LO�1D �UI�OING 5 PJV�W J �W <br />PLUM�ING � <br />FIFj�ZONE �ASEMENT FIRESPRINKLl:f15 _ <br />� - RCDUIRED I <br />❑VES ❑NO MECHAtJICAL � <br />.^,P�ECIAL CONOITIONS: OTHER � <br />PENELTV SEC.J071n1 � <br />L� _ <br />TOTAL 5 � <br />PERMIT VALIDATION <br />— WH@N PROPERLY VALIDATED (IN THIS SPACE) THIS IS VOUR PERNIT <br />�PPLICAiIONACCCCTE00Y�. �LAHSbICCNCpI1Y. �i'PpOV[Of0(i15SUANL[IIY <br />�C� �� <br />� <br />