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the FFrrphrn <br />CITY Of <br />eve rett <br />L11 MAIL . <br />EVE NETT, W\SWNETUN <br />UNIT <br />DEFT DI COMMON-TY BUILDING <br />DIVELDPMENT <br />CONSTRUCTION <br />"INIT, 111-1 <br />MECHANICAL <br />everett <br />PLUMBING �e�� <br />OWNER MAIL ADDRESS ZIP PHONL <br />r4ftnr o-was ym rodalftlur <br />!^+ �• t <br />e� / <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE I ICENSE NO. <br />GENERAL CONTRACTUR MAIL ADDRESS PHONE LICENSENO. <br />�a�.Clr+J6 <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />cc <br />LU <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />❑ BUILDING ❑ PLUMBING MMECHANICAL <br />CLASS OF WORK <br />El NEW ❑ADDITION ❑ALTERATION REPAIR <br />Z <br />VALUATION OF WORK <br />S <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />cc <br />LU <br />DESCRIBE WORK <br />1169 <br />FROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL ❑OIL <br />❑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 />$ 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 />I <br />JOB ADDRESS r <br />yM ,�.a.., <br />.7 i'.EI M�✓��-g <br />WALL HEATERS—B.T.U, NA <br />UNIT HEATERS—B.T.U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I _ <br />VENTILATION FAN <br />RANG <br />AIR HANDLING UNIT- C.F.M. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />INCINERATOR <br />I <br />WATER CLOSET (TOILET) <br />S <br />BATHTUB <br />JL <br />7�� — <br />- <br />LAVATORY(WASHBASIN) <br />SHOWER <br />KITCHEN SINK P DISP. <br />SUBT15TAL S <br />DISHWASHER <br />PERMIT $ <br />LAUNDRY TRAY <br />TOTAL FEE S <br />CLOTHES WASHER <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 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 T141S 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 />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR- SINK OR DRAIN <br />K <br />VACUUM BREAKERS <br />ROOF DRAINS AINLEADE RS <br />SINK (SERVICE -BAR, ETC.) <br />— <br />SUB TOTAL <br />PERMIT <br />S <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 />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />I <br />_ <br />BUILDING <br />S <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX, OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />FIRESPRINKLERS <br />R Oy[ ED ONO <br />MECHANICAL <br />OTHER <br />9 I m <br />SPECIAL CONDITIONS: <br />- <br />- <br />- <br />PENELTY <br />SEC. 303 la) <br />I <br />TOTAL <br />tl <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />Q <br />APPLICATION ACCEPTED BY: <br />PLANSCNECKEEIBY: <br />l <br />APPROVED FOA ISSUANCE BY. <br />nf — <br />