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the Evergreen <br />CITY OF <br />everett <br />LITYIIAIL )'AE..i'. <br />IVERITL WASHINCTO' <br />98711 <br />DEPT. OF CUM MDR Iry BUILDING <br />OEVELOPMI N. <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />evereG <br />PLUMBING �.e <br />OWNER MAIL ACURLSS ZIP PHONE <br />w vrm= 03 <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />MERA'NI$AL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />m <br />PERMIT <br />��PP <br />Cl BUILDING ❑ PLUMBING (ZMECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑..ITERATION XJREPAIR <br />D <br />Z <br />1- <br />VALUATION OF WORK <br />$ <br />[I DEMOLISH ❑FENCE ❑SIGN []SWIMMING POOL <br />LU <br />DESCRIBE WORK <br />MWAM IrAlEr' <br />19 2 4 <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL ❑OIL ❑GAAS. ❑LPG. ❑ELEG. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />NO. <br />TYPE OF EOUIPMENT <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 />_ <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />I <br />JOB ADDRESS <br />a� <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />1 <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <br />I <br />AIR HANDLI14G UNIT- C.F.M. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />$ <br />INCINERATOR <br />I <br />BATHTUB <br />low laaw <br />LAVATORY (WASH BASIN) <br />I <br />SHOWER <br />KITCHEN SINK A OISP. <br />SUB TOTAL $ <br />i <br />DISHWASHER <br />PERMIT S <br />LAUNDRY TRAY <br />TOTALI $ <br />1 <br />CLOTHES WASHER <br />WATER HEATER <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 />- <br />X <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />$ <br />TOTAL FEE <br />$ I <br />SIGNATURE OF CONTRACTOROR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />_ <br />I <br />BUILDING <br />S <br />I <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />I <br />FIRE ZONE <br />_ <br />BASEMENT <br />FIRE:RPR I NKLE RS <br />R'GUIRED <br />❑YES ❑NO <br />- <br />MECHANICAL <br />J I� <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />I <br />PENELTY <br />SEC. 000 (A) <br />I <br />TOTAL <br />1 <br />_ <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) "'HIS IS YOUR PERMIT <br />— <br />APPLICATION ACCEPTED BY <br />I TANS CHECKED BY APPROVFDIOh <br />ISSOAI. <br />