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the Evergreen <br />CITY OF <br />everett <br />CITY HAIL 259 BUS <br />EVERETT. WASHMOTCR <br />99}OI <br />BEN. OF COMMUNITY BUILDING <br />BEVEI OeVINT <br />CONSTRUCTION <br />MECHANICAL <br />everett <br />PLUMBING �e <br />OWNER MAIL ADDRESS ZIP PHONE <br />i(ArZ- JM-S Y430 <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />C. MT-S., .h► M& 'W"M <br />MECHANICAL CONTRACTOR MAI- ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />LU <br />m <br />PERMIT <br />BUILDING ❑ PLUMBING ❑ MECHANICAL <br />CLASSOFWORK <br />❑NEW ❑ADDITION ❑ALTERATION XnEPAIR <br />2 <br />Z <br />F <br />VALUATION �OF WORK <br />$ I�RN/EP ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />DESCRIBE WORK <br />(7: <br />G <br />1688 <br />PROPOSED USE <br />MECHANICALA. <br />TYPE OF FUEL ❑OIL ❑GAS ❑LPG. ❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR AT TACN <br />FOUR COPIES) <br />LOT BLOCK —OF <br />- <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND, UNITS-H.P. EA. <br />$ I <br />REFRIGEF ATION IINITS-H.P. EA. <br />BOILERS-H.P. EA. <br />I <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.V. MEA. <br />I <br />JLB ADDRESS .yFTONN�yR <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />_ <br />RANGE HOOD <br />I <br />AIR HANDLING UNIT- C.F.M. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />$ <br />INCINERATOR <br />1 <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />1 <br />SHOWER <br />KITCHEN SINK & DISP. _ <br />SUB TOTAL 4 <br />I <br />DISHWASHER <br />PERMIT S <br />LAUNDRY TRAY <br />TOTALFEE S <br />I <br />CLOTHES WAS)/ER <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 THIS TYPE <br />OF V.ORK 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 />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -LIAR, ETC.) <br />SUBTOTAL <br />PERMIT <br />4 <br />TOTALFEE <br />SIGNATURE OF CONTRACTOROR AUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK IPI <br />YARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE (RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANTSITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITS DWELLING <br />BUILDING <br />4dNN <br />V po <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />I <br />FIRE ZONE <br />BASEMENT <br />FIRESPRINKLERS <br />REQUIRED <br />DYES ❑NO <br />MECHANICAL <br />1 <br />SPECIAL CONDITIONS: <br />OTHER <br />i <br />1 <br />FENELTY <br />SEC. 303 W <br />I <br />TOTAL <br />V <br />- <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />0 <br />APPLICATION ACCETTED BY <br />PLANS CHECKEO BY: APPROVEDYFORI <br />BAME OY. <br />�M Q� <br />