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everett <br />CIrVHALL 1]9RRSA <br />EVERETT IVASHIN6TON <br />9E101 <br />OEPT. OF COMMUNITY BUILDING <br />Or VILOPMENT <br />PERMIT <br />MECHANICAL <br />lePLUMBING _ <br />OWNER y�E MAIL ADDRESS ZIP PHONE <br />.fw, � t =h IEA�SIt V <br />iACr76 <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 />3 0 E <br />X <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />LU <br />m <br />2i <br />PERMIT <br />❑BUILDING []PLUMBING MECHANICAL <br />CLASS OF WORK <br />❑[]ADDITIONpr <br />NEW ADDITION ❑ALTERATION Y.IREPAIR <br />:D <br />~ <br />VALUATION OF WORK <br />5 <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />cc <br />LU <br />G. <br />- <br />DESCRIBE WORK <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL [-]OIL ❑GAS. ❑LPG. ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES( <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 />I <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.'T.U. M EA. <br />JOB ADDRESS <br />J.I4tS n-'�• <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />I _ <br />- <br />VENTILATION FAN <br />RANGE HOOD <br />AIR HANDLING UNIT- C.F.M. <br />TYPE OF FIXTURE OI: ITEM <br />FEE <br />INCINERATOR <br />I <br />[.DISHWASHER <br />WATER CLOSET (TOILET) <br />S <br />BATHTUB <br />LAVATORY (WASH BASIN; <br />SHOWER <br />KITCHEN SINK & DISP. <br />UBTOTAL 5 <br />PERMIT 5 <br />LAUNDRY TRAY <br />TOTAL FEE S <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR LONSTRuc <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 EXAM IN: D THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ORDINANCES GOVERNING THIS TYPE <br />ED WITH WHETHER SPECIFIED HEREIN <br />OF WORK WILL BE COMPLIED <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 W 2�l (v � /1 3/76 <br />WATER HEA, ER <br />U Rit'..�L <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADE RS <br />SINK (SERVICE -BAP, ETC.) <br />- <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 />ITO UNITS DWELLING <br />BUILDING <br />S <br />I <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />INKLERS <br />*REOUIRID <br />❑NO <br />MECHANICAL <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />I <br />PENELTY <br />SEC. BOB (a) <br />I <br />TOTAL <br />- <br />-- - <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />A <br />APPLICATION ACCEPTED BY: <br />PLANS CHECKED BY: <br />[PPKUVLU rUM ISSUANCE BY. <br />le et <br />