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the Evergreen <br />CITY OF <br />everett <br />CITY HALL 159EMS <br />EVERETT, WASHINGTON <br />9E101 <br />DEPT, OF COMMUNITY BUILDING <br />DEVELOPMENT <br />CON,s"fRUCTION <br />MECHANICAL <br />everett <br />PLUMBING ie <br />OWNER MAIL ADDRESS LIP PlIONL <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />_ wi ma's. <br />MECHANICAL CONTRACTOR MAIL ADDRESS `HONE LICENSE NO. <br />Y <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />ED <br />PERMIT <br />s <br />L]'BUILDING []PLUMBING ❑MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION REPAIR <br />D <br />Z <br />VALUATION OF WORK Ey� <br />S �W <br />❑DEMOLISH [:)FENCE ❑SIGN ❑SWIMMING POOL <br />iL <br />W <br />a. <br />DESCRIBE WORK <br />510 <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL ❑OIL ❑GAAS. []LPG. ❑ELEC. <br />NO. TYPE OF EQUIPMENT FEE <br />LEGAL DESCRIPTION OF PROPER Y (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK— OF <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 />1 <br />JOB ADDRESS y yy�9 <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />1 <br />PLUMBING <br />EVAPORATIVE COOLERS <br />_ <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAN <br />RANGE HOOD <br />1 <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 />$ <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I <br />SHOWER <br />_ <br />KITCHEN SINK &DISP. <br />_+ <br />SUBTOTAL S <br />1 <br />DISHWASHER _ <br />PERMIT S <br />LAUNDRY TRAY <br />TOTAL FEE S <br />1 <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 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 />X <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUMBREAKERS <br />ROOF DRAINS-gAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />$ <br />TOTALFEE <br />$ <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT OATS <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USEZONE <br />LOT ARFA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OSF DWELLING <br />UNIT <br />BUILDING <br />S� <br />>� d <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE BONE <br />BASEMENT <br />FIRE PRINKLERS <br />RfD <br />❑YES YES []NO <br />MECHANICAL <br />I <br />SP_CIAL CONDITIONS: <br />OTHER <br />I <br />PENELTY <br />SEC. BOO(a) <br />1 <br />_ <br />TOTAL <br />1 <br />5101 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />it <br />APPLICATIDN ACCEPTED BY: PLANS CHECKED BY: <br />APPROVED FOB ISSUANCE BY. <br />