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the Evergreen <br /> CITY OF CONSTRUCTION everett <br /> everett PERMIT <br /> City HALL JHRNf <br /> IVFRIII WASHINGLDN <br /> glint <br /> °`"' °Df FLDMENt BUILDING MECHANICAL PLUMBING <br /> OWNER MAIL ADDRESS CII' I'l IIINL <br /> ATl�lf �!'dOd 21>'rl77 <br /> AFICHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br /> GENERAL 80111 �C�WWOFE��N TR��ggAWWC�TTORO <br /> MAIL ADDRESS PHONE LICENSEN . <br /> `w lIANV 6 353d= <br /> MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br /> PLUMBING CONTISACTOR MAIL ADDRESS PHONE LICENSE NO. Ir <br /> LU <br /> m <br /> P[I fJM1T CLASS OF WORK D <br /> Z <br /> ❑BUILDING ❑PLUMBING (]MECHANICAL )... <br /> ' ❑NEW ❑ADDITION [)ALTERATION CbEPAIR <br /> VALUATION O��FI WORK <br /> $ <br /> �7)" ❑DEMOLISH ❑FENCE ❑SIGN []SWIMMING POOL LU <br /> DESCRIRF WORK -- <br /> mwr 417 -4- -056 <br /> PROPOSED USE <br /> MECHANICAL <br /> TYP OF FUEL OOIL NAT. LPG. ❑ELEC. <br /> LLGAL DESCRIPTION OF PROPERTY(SHOW BELOW OR I TTACH OAS <br /> FOURCOPIES) <br /> � • <br /> Lor <br /> J� BLOCKA-O AM ' NO. TYPE OF EOUIPMF.NT FEE - - __ <br /> AIR COND.UNITS-H.P. EA. S I <br /> REFRIGERATION UNITS-H.P. EA. - <br /> BOILERS-H.P.EA. j-- <br /> OAS FIRED A.C.UNITS-TONNAGE EA. �- <br /> 1 <br /> _ FORCED AIR SYSTEMS-B.T.U. M EA. 1 <br /> JOR nDD RE55 `�'� _ WALL HEATERS-B.T.U. M <br /> 510 �` UNIT HEATERS-B.T.U. M 1 ____ <br /> PLUMBING EVAPORATIVE COOLERS <br /> CLOTHES DRYERS 1 <br /> VENTILATION FAN <br /> RANGE HOOD I _ <br /> AIR HANDLING UNIT- C.F.M. �- <br /> NO. TYPE OF FIXTURE OR ITEM FEE - <br /> WATERCLOSET(TOILETI f INCINERATOR I _ <br /> BATHTUB <br /> LAVATORY(WASH BASIN) I <br /> SHOWER <br /> KITCHEN SINK d DI7P. SUBTOTAL f ) <br /> DISHWASHER 1 — <br /> LAUNDRY TRAY I--- PERMIT f <br /> TOTALFEE S 1 <br /> CLOTHES WASHER THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br /> WATER HEATER TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS. OR IF <br /> URINAL CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br /> DRINKING FOUNTAIN PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br /> r LOOR-SINK OR DRAIN I HERESY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br /> VACUUM BREAKERS PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> ROOF GRAINS-RAINLEAOERS PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK W'LL BE COMPLIED NITH WHETHER SPECIFIED HEREIN <br /> SINK (SERVICE-BAR ETC.) OR NOT. THE GRANTING OF 4 PERMITDOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATA. OR CANCCL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL E AW RE.ULATING CONSTRUCTION <br /> eU070TAL OR THE PERFORMANCE OF CONS7RLFCTION. <br /> PERMIT f <br /> TOTALFEE $1 1 <br /> x <br /> SIGNATURE OF CONTRACTOR OR AUTH AGENT DATE <br /> SIDE YARD SETBACK STREETSETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> ❑YES ONO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP NO.OF DWELLING <br /> UNITS I <br /> SIZE OF BLDG. NO.OF STORIES MAX.OCC. LOAD BUILDING S , <br /> PLUMBING <br /> FIR ONE BA N I 1 KL <br /> RFOUIRED -� <br /> OYES ONO MECHANICAL I <br /> SPECIAL CONDITIONS: OTHER <br /> - I <br /> - --- - PENELTY SEC.303(R) I <br /> TOTAL q <br /> PERMIT VALIDATION <br /> WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS TOUR PERMIT <br /> 1110.A11ONAMPTEOHT 1'IANSCNI'LIlLI1 HY- - d1Y uyp111111AI61AIMIEV <br /> La <br /> e <br />