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the Evergreen <br />CITY OF <br />everett <br />CITY "ALE RESEAL <br />EVEN TT, WASNINGTON <br />Is"$ <br />OEPT OR COMMUNIit BUILDING <br />OEVEEUNI NI <br />CONSTrUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING 1.e�� <br />OWNER MAIL ADDRESS ZIP PHONE <br />yto &I two Jiff ttd.010H, UM 63M <br />ARCHITECT <br />)I OR DESIGNER MAIL ADDRESS xxPHONE LICENSE NO. <br />oT w NISIIm 35 <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />/ <br />ai7�17i <br />�i77 <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />LU <br />ED <br />m <br />PERMIT <br />BUILDING ❑ PLUMBING []MECHANICAL <br />CLASS OF WORK <br />[I NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />� <br />Z <br />I_ <br />i <br />VALUATION OF WORK <br />♦[yy�_JN <br />❑DEMOLISH ❑FENCE ❑SIGN []SWIMMING POOL <br />Ir <br />W <br />DESCRIBE WORK <br />Adow 4m <br />q /� <br />12O3 <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF UEL OIL NAT. LPG. ELEC. <br />GAS <br />LEGAL DESCRIPTION OF PROPERTY ESHOW OELOW OR ATTACH <br />FOU ESI <br />LOT BLOCK 1 GF � r Di!e a <br />NO. <br />TYPEEQUIPMENTFEE___ <br />AIR COND. UNITS-H.P. EA.. <br />$ 1 _ <br />REFRIGERATION UNITS-H,P. EA. <br />BOILERS-H.P. EA. <br />I <br />GAS FIRED A.G. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />1 <br />JOB ADDRESS <br />2m 0114 ftw <br />WALL E[EATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <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 ITOI LET) <br />f <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & OISP. <br />SUBTOTAL f <br />I <br />DISHWASHER <br />PERMIT f <br />LAUNDRY TRAY <br />TOTALFEE f <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 />//O�� /� <br />X L JLYl�4'. - YE_ 011-k_ <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR —SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF GRAINS—RAINLEADE RS <br />_ <br />SINK (SERVICE —BAR ETC.) <br />SUBTOTAL <br />PERMIT <br />f <br />TOTAL FEE <br />f <br />SIGNATURE OF CONTRACTOROR AUTH.AGENT DATE <br />SIDEYAROSETBACK <br />STREETSETBACK <br />REARYARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />I <br />BUILDING <br />S M <br />IRNI� <br />M�/y / IM <br />SIZE OF BLOC. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />E <br />FIRE 2 N <br />BAS M T <br />IR S RINK RS <br />REQUIRED <br />❑YES ONO <br />MECHANICAL <br />1 <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />PENELTY <br />SEC. 303 (a) <br />I <br />_ <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />Q <br />rPP TIONACLEPT[ORv <br />Pi ANSOCI[e 91 APPRIM <br />f— O�'A11AURMCC BY�I M <br />