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L1 <br />the Evergreen <br />CITY OF <br />everett <br />CITY HALL 255 LB[5 <br />EVERETT. WASNINGTON <br />RINI <br />DEPT. Or COMM C111TY BUILDING <br />DEVELOPMENT <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />OWNER MAIL ADDRESS <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />GENERAL CONTRACTOR MAIL ADDRESS <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />3AM <br />PLUMBING CONTRACTO9 MAIL ADDRESS <br />`J. s <br />PERMIT <br />❑ BUILDING 70PLUMBING {] MECHANICAL <br />CLASS OF WORK <br />NEW <br />VALUATION OF WORK <br />$ <br />❑ DEMOLISH <br />DESCRIBE WORK <br />PROPOSED USE <br />LEGAL OUR DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />LOT BLOCK —OF <br />JOB ADDRESS ��,,/���I� <br />Ai71.aomm In, <br />PLUMBING <br />TV PE OF FIXTURE. OR ITEM <br />F <br />UM <br />WATER CLOSET (TOILET) <br />$ <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />$ <br />TOTALFEF <br />S <br />S1DE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC, LOAD <br />FIRE ZONE <br />BASEMENT <br />FIRES RINKLERS <br />RF.OUIRED <br />DYES []NO <br />SPL:CI'AL CONDITIONS: <br />APPLICATION ACCEPTED BY: <br />PLANSCHECKEDBY'. APPROVED <br />FOP ISSUANCE BY. <br />� )Rr <br />f <br />PLUMBING <br />PHONE <br />3':'S-3!3A <br />❑ADDITION ❑ALTERATION ❑REPAIR <br />❑FENCE ❑SIGN ❑SWIMMING POOL <br />MECHANICAL <br />REFR <br />FIRED A.C. UNITS-TONNAG <br />'ED AIR SYSTEMS-B.T.U. M <br />L HEATERS-B.T.U. M <br />' HEATERS-B.T.U. M <br />AIR <br />INCI <br />everett <br />�.e <br />5n.? <br />S <br />432 <br />w <br />U.J <br />m <br />z <br />F- <br />LU <br />W <br />Q. <br />SUBTOTAL <br />_ PERMIT $ <br />TOTALFEE S�-- <br />1 -�- <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION nR 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. ALI. <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIEO 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 />X .fir,-^ <br />SIGNATURE OF CONTRACTOROR AUTH.AGENT DATE <br />'LAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />FEES i VALUATION I FEE <br />BUILDING <br />$ <br />PLUMBING <br />x7 <br />MECHANICAL <br />7 <br />DTHER <br />PENELTY <br />SEC. 003 IA) <br />TOTAL <br />Io <br />PERMIT VALIDATION <br />MIEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />