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The Evergreen <br />CITY OF <br />everett <br />CITY HALL 299899S <br />EVERETT, WASHINGTON <br />98201BUILDING <br />DEPT. OF COMMUNITY <br />TY <br />DEVELOPMENT <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING <br />OWNER MAIL ADDflE55 ZIP PHONE�� <br />t <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAILADDRESS PHONE LICENSE NO. <br />UJ <br />co <br />PERMIT CLASS <br />❑ BUILDING ❑ PLUMBING 15MECHANICAL <br />OF WORK <br />NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />D <br />Z <br />F- <br />VALUATION OF WORK <br />❑DEMOLISH ❑FENCE ❑SIGN [:]SWIMMING POOL <br />S <br />DESCRIBE WORK =71M 30p. � <br />n <br />cc <br />LU <br />C. <br />227 <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL []OIL ❑GAAS. ❑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. is <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 A. <br />I <br />JOB ADDRESS <br />L+/�// QtY! Y�r.. 1� <br />.7Mp� i✓04 Oft <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGE HOOD <br />I <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 />SUBTOTAL S <br />PERMIT S <br />TOTALFEE $ <br />I <br />Alm <br />I uu <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP. <br />DISHWASHER <br />LAUNDRY TRAY <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 1 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 />OR NOT, THE GRANTIINGOF WORWILL BE LIED WITH OF A PERMITTHER DOES NOT (FIED 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 />�9 <br />E'1S <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAWSAIE <br />SINK (SERVICE- -BAR,R, ETC.)TC.) <br />SUBTOTAL <br />PERMIT <br />$ <br />TOTALFEE <br />S <br />SIGNATURE OFCONTRACTOROR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT Ar1EA <br />VACANT SITE <br />OYES []NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />UNITS DWELLING <br />I <br />BUILDING <br />S <br />I <br />I <br />SIZE OF BLOC. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEM NT <br />FIRES RINKLERS <br />REQUIRED <br />OYES ❑NO <br />MECHANICAL <br />pT <br />--7 <br />I <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />PENELTY <br />SEC. 303 (a) <br />I <br />TOTAL <br />oeoaalT V AI IDATION <br />I� <br />WHEN PROPERLY VALIDATED (IN THIS SPACE <br />