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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 259.8741, <br />EVERETT. WA 98201 <br />CONSTRUCTION <br />PERMIT <br />COMBINATION • EUILDING • MECHANICAL <br />• everett <br />PLUMBING <br />OWNLR MAIL ADLFILSS LIP POUNL <br />Geraldine Natteson 2131 McDougal 252-5989 <br />ARCHITECT OR DESIGNLR MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />Same <br />MECHANICAL CONTRACTOR MAIL ADDRESS PRONE LICENSE NO. <br />PLUMBING CONTRACTOR - MAIL ADDRESS PHONE LICENSE NO. <br />m <br />z <br />01 <br />m <br />PERMIT CLASS <br />❑COMBINATION <br />❑BUILDING PLUMBING ❑MECHANICAL <br />OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />VALUATION OF WORK <br />❑DEMOLISH ❑FENCE ❑SIGN []SWIMMING POOI. <br />DESCRIBE WORK <br />PROPOSED USE <br />MECHANICAL _ <br />TYPE OF ENERGY <br />❑ GAS ❑ E LEC. <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-M.P. EA. <br />$ 1 <br />REFRIGERATION UNITS--M.P. EA. <br />I _ <br />BOILERS-H.P. EA. <br />1 <br />FORCED AIR SYSTEMS-O.T.U. MEA. <br />I <br />JOB ADDRESS <br />SPACE & WALL HEATERS - B.T.U. <br />UNIT HEATERS B.T.U. <br />1 <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />1 <br />�- <br />-VENTILATION <br />FAN <br />RANGE MOOD <br />NO. <br />TYPE OF FIXTUREa <br />E <br />AIR HANDLING UNIT- C.F.M. <br />I <br />BATH TUBS <br />CLOTHES WASHC <br />1 <br />WATER HEATER _ <br />DISH WASHERSI <br />FAC. BUILT FIREPLACE & CHIMNEY <br />1 <br />DRINKING FOUN1 <br />GAS. SYSTEM: NO OP OUTLETS <br />FLOOR DRAINSI <br />SUBTOTAL $ <br />I <br />KITCHEN SINKS1 <br />PERMIT S <br />TOTAL FEE $ 1 <br />_ <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 1 HAVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAME TO RE 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 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION, <br />�J �/ _ <br />5-2-79 <br />SIGNATUREO CONTRACT RO VTH. AGENT DATE <br />PLAN CHECK NUMBER PLAN Cl/ECK FEE <br />FEE RECEIPT NO. <br />BAR SINKS <br />ROOF DRAINS -RAIN LEADERS <br />SHOWER BA <br />I <br />SERVICE SINKS <br />SUMPS - SEWAGE PUMP <br />URINALS <br />_� <br />WATER CLOSETS <br />1 <br />WATER HEATERS - ELECTRIC <br />I <br />WASH BASINS <br />1 <br />LAUNDRY TRAYS <br />I <br />SUB TOTAL <br />Z i0 <br />TOTAL FEE <br />WATER SERVICE SIZE_ SLOG. SUPPLY SIZE <br />SIDE YARD SETBACK REAP YARD SETBAC <br />USEZGNE <br />7TRELTSETBACK <br />VACANT SITE❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPEOFCONST <br />SIZE OF BLOC. <br />GRCOP <br />NO. OF STORIES <br />UNITS DWELLING <br />MAX. OCC. LOAD <br />1 <br />BUILDING <br />$ <br />I <br />1 <br />PLUMBING <br />5 100 <br />_ZONE <br />BASEMENT <br />FIRE SPRINK L F R S <br />REOUIREO <br />[]YES ONO <br />— <br />MECHANICAL <br />1 <br />1 <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />PENALTY <br />SEC. 0001a) <br />TOTAL <br />510 0 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED UPI SIISJIIACE$ NIff XI IR PE <br />OI,bVuU <br />'YOUR RECEIPT --I <br />THANK YO U rrl <br />0 . <br />— — <br />-- <br />_ — <br />AMUCAIION ACff Vf111 NY <br />VI ANS I]IIlRl I1 tlY <br />APPIIOVLOIOII I;SIIANf:E BY <br />DDRESS Ft <br />