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t0c Evergrten <br />CITY OF <br />everett <br />tnv iuu is�esas <br />EVEP[R. 1Y4FMINGiON <br />9E}01 <br />°�°, °`°°^"'°�°' BUILDING <br />OIV[lOVMFHt <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL PLUMBING <br />everett <br />OWNER MAII. AODRE55 21P i'IiONE <br />ij:i^s�' csrrs.•^!� ZJ'��72 :LZ�%r <br />ARCMITECT OR DESIGNER MNL ADDRE55 PHONE LICEN'E NO. <br />GEpN�EFAL COtVTRACTOfi MAIL ADDRESS PHONE LICENS[ NO. <br />�]C�YI� <br />MECHANIGAL CONTRACTOR MAIL ADD(iESS PHONE LICENSE NO. <br />PWM6INGCONTPACTOR MAILADDR[SS PHONE LICENSENO. � <br />W <br />m <br />PERMIi CL/�550� WORK � <br />Z <br />�6UILDING ❑PLUMOING �MEC11l�NICA� � <br />❑NEW ❑F�OITION ❑ALTERATION ❑fiEPA1R � <br />VALUATION OF WORK <br />5 /M � �pEMO'.�SH ❑FEYCE ❑SIGN ❑SWIMMING POOL a <br />�M <br />DESCRIBF WORK �s (t�c��y C vn ���0 <br />�.�1�W��i �ai�i�1A� r�i}�Y i�.'� i�..4.'2V <br />PqOPOSEO USE MECHANICAL <br />L[GA� OESCRIPTION OF PROPERI V ISHOW RELOW OR ATTACH TVPE OF FUEL �011 ❑GAS ��-PG. �ELEC. <br />FOUfi COPIESI ./�� <br />LOT Ol0[K_L�IfoF ��� •'A�•n � NO. TVPE OF EQUIPMENT FEE <br />AIR CON�. UNITS—H.P. EA. $ I <br />��J!� h Q� ,J g/lft/ �.f 1J 1 REFRIGERl�TION UNITS-H.R EA. <br />oa 1� 7�Mi Y.i ��7 fi aW i pOILEftS-II.R EA. I <br />i�/15 fIREO f�.G. UNITS-TCNNAGE EA. <br />FORCED AIP SYSTEMS-O.T.U. M EA I <br />JOB ADDRE55 q��� WILLL HEI�TEfiS-R.T.U. M <br />� S/��'" S� i�F:, UNIT HEATERS-O.T.U. M I <br />PLUMBING W„ ��(� evnronnnve coo��as <br />'i �Y'�""'u'+it� CLO?HES DRVERS � <br />VENTILATION FAN <br />RANGEHO00 I <br />NO. TVPE OF FIXTURE OR ITEM FEE ��A ���NOLING UNIT— C.F.M. <br />WATERCLOSETITOILETI g �NCINERATOfi I <br />�ATMTUB <br />LAVATORV IWASH BASINI I <br />SHOWER <br />KITCHEN SINK & DISP. SUO TOTAL 5 <br />DISHWASNER �— PERMIT 5 � <br />LAUNDqV TRAV � <br />TOTAL FEE 5 � <br />CLOTHES WASNER THIS PERMIT pECOMES NULL AND VOID IF WOHK OR CONSTRVC- <br />WATEfl NEATER TION �UTHORIZED IS NO' COMMENCED WITMIN 120 DAYS, Oti IF <br />URINAL � CONSTNUCTION OR WOPK IS SUSPENDEO OH ApANDONED FOfl A <br />DRINNING FOUNTAIN �'ERIOD Of- 120 DAVS �T ANV TIME AFTER WORK IS COMMCNCED. <br />FLOOR-SINK OR DRAIN � ��EPEOV CERTIFV THAT I HAVE FEAD ANO E%AMWLO THIS AP- <br />VACUUM pFEAKERS PLiCATION ANO KNOW THE SAME TO OE T(iVE ANO CORRECT. �1LL <br />ROOF DfiAINS-RAINI.EAO[RS PROVISIONS OF LAK'S AhD OfiDINnNCES GOVEqNING THIS TYYE <br />OF WORK WILL BE COMPLIED WITH WHETHEH $PFCIFI[D MEHEIN <br />SINK ISERVICE-DAR, ETC.) OR NOT, THL GPANTING Of 11 PEPMIT DOES NOT PRESUMB TO <br />GIVE nUTHORITV TO VIOLATE OR CANCEL TNE PROVISIONS OF <br />ANY OTM@R STAiE OR LOCAL I.AW REGULATING CONSTRVCTION <br />OR THE PERFORM�NCG OF CONSTRUCTION. <br />SUU TOTAL <br />PEfiMIT 5 � <br />TOTALFEE S <br />x �� <br />SIGNATUFEOPCON�fiACTU(iOR�lUT11.AG[NT OATE <br />SIOE YARD SET�ACK STRE[T SETAACK REAR VARDSETBACK PLAN CHECK NUMb[li PLAN CNECK FEE <br />FEE RECEIPT NO. <br />USE ZONE LOT AREA V/�CANT SITE <br />❑vEs ❑No FEES VALUATION FEE <br />TVPL OF CONST. OCCUPANCY GRDUP NO.OF DWELUNG <br />UNITS I <br />M— 1 <br />SIZE OP BLDG. NO. OF S10fl1E5 MAX.00C. LOAD 6UILDING 5 �yy � �� <br />PI_UMBING � <br />FIREZONE [3ASEMENT FI(i[SPqINKLEfiS <br />ftfOUIHED I <br />❑VES ❑NO �4ECHAqICAL � <br />SPCCIALCONDITIONS: OTHEft � <br />— I <br />PENELTY SEC. �031a) I <br />I <br />— TOTAL � j� <br />PERMIT VALIDATION <br />WHEN PROPERLV VlLLIC�AT[O (IN t11155PACF) T111515 VOUR �'ENA11I <br />PVCLIU11pNACCLPi[DBY' OLANSCHCCKE08Y: A�PIIOVCOFOQIS'.UnISF�T <br />1• ^� <br />3 <br />