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The Evergreen <br /> CITY Of CONSTRUCTION evereH <br /> everett PERMIT <br /> U1Y HAI( HBFBFI <br /> 1 Vf 11f II.WASHI46I0W <br /> N101 <br /> DEPT °ff°E,°VB11Y <br /> BE VLLBBBINt BUILDING MECHANICAL PLUMBING <br /> OWNER MAIL ADDRESS ZIP tLl'CENSE <br /> nm cmenu 24,20 best _ 2"ONEzr�,a7G <br /> ARCHITECT OR DESIGNER MAIL ADDRESS PHONE NO. <br /> GENERAL CONTRACTOR MGIL ADDRESS PHONE NO. <br /> MECHANICALCONTRACTOR MA L ADDRESS PHONE LICENSE NO. <br /> PLUMBING CONTRACTOR M,"L ADDRESS PHONE LICENSE NO. w <br /> W <br /> 0] <br /> PERMIT CLASS OF WORK � <br /> z <br /> ❑BUILDING PLUMBING ❑MECHANICAL 0 14E ❑ADDITION ❑ALTERATION 8REPAIR ~ <br /> _ 2 <br /> VALUATION OF WORK J cc <br /> ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL W <br /> $ -----D_ <br /> DESCRIBE.WORK 1570 <br /> PROPOSED USE MECHANICAL <br /> _ <br /> TYPE OF FUEL OILNAT. LPO. ELEC. <br /> LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH GAS <br /> FOUR COPIES( <br /> Lor BLOCK—OF ' _ _ NO. TYPEEQUIPMENT FEE <br /> AIR COND.UNITS-S-MAP. EA. S 1 <br /> REFRIGERATION UNITS-H.P.EA. <br /> BOILERS-H.P.EA. I <br /> GAS FIRED A.C.UNITS-TONNAGE EA. <br /> FORCED AIR SYSTEMS-B.T.U. M EA. I _ <br /> JOB ADDRESS ,F�� WALL HEATERS-S.T.U. M <br /> 900 ': UNIT HEATERS-B.T.U. M I <br /> EVAPORATIVE COOLERS <br /> PLUMBING CLOTHES DRYERS I <br /> VENTILATION FAN 1 <br /> RANGE HOOD I <br /> NO. TYPE OF FIXTURE OR ITEM FEE AIR HANDLING UNIT- C.F.M. <br /> WATER CLOSET(TOILET) g INCINERATOR I _ <br /> BATHTUB — <br /> _ LAVATORY WASHBASIN) I - - <br /> SHOWER <br /> KITCHEN SINK&DISP. ig SUB TOTAL S I - <br /> DISHWASHER PERMIT S _ <br /> LAUNDRY TRAY TOTALFEE $ I <br /> CLOTHES WASHER THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC. <br /> WATER HEATER TION AUTHORIZED IS NOT COMMENCED WITHIN IZO DAYS, OR IF <br /> URINAL CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br /> DRINKING FOUNTAIN PERIOD OF 170 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br /> FLOOR-SINK OR DRAIN 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br /> VACUUM BREAKERS PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> ROOF DRAINS-RAI NILE AGE RS_ OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> 1 , ETC.) OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> RNA GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> _ IL iiiiilm, OR THE PERFORMANCE OF CONSTRUCTION. <br /> SUB TOTAL <br /> PERMIT S <br /> TOTALFEE S <br /> X <br /> SIGNATURE OF CONTRACTOR OR AUTH.AGENT DATE <br /> SIDEYARDSE78ACK STREETSETBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> OYES ONO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP UN108 DWELLING <br /> SIZE OF BLDG. NO.OF STORIES WAX.OCC. LOAD BUILDING $ <br /> PLUMBING TI <br /> OO <br /> FIR D BAS M N grGUIREDKL <br /> OYES ONO MECHANICAL I <br /> 1 <br /> SPECIAL CONDITIONS: OTHER <br /> _ PENELTY SEC,303 111) I <br /> — - TOTAL I I <br /> 00 <br /> PERMIT VALIDATION <br /> WHEN PROPERLY VALIDATED(IN THIS SPACEI THIS IS YOUR PERMIT <br /> eBPUdHION ArCf PTID BY PLANSC FCPED9Y APPROVED FOAIMUTAW1 BY <br /> f.M <br /> 0 <br />