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The Evergreen <br />` <br />CITY OF <br />CONSTRUCTION rveretl <br />everett <br />PERMIT <br />nr NAu raeees <br />I vfcm wxsRlncmx <br />' <br />Neral <br />1111.1 COMMIINIfY BUILDING <br />MECHANICAL PLUMBING <br />CUvf YIPMUNr <br />.e <br />OWNERH MAIL AUUFSS <br />Rw I- <br />rIA MIMI- <br />ZIP <br />J7l55__ O'!'lU�9`f,^Y'• _INL <br />N rj <br />20-71�ry <br />ARCHITECTOR DESIGNER MAIL ADDRESS <br />PHO WE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />MECHANICAL CONTRACTOR( MAIL ADDRESS <br />PHONE LICENSE NO. <br />2 <br />li t1M81NG CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />LU <br />RMIT <br />FFfs <br />CLASS OF WORK <br />Z <br />,, <br />G <br />Lry BUILDINMPLUMBINO QJ MECHANICAL <br />❑NEW <br />11���� <br />L/IADDITION ❑ALTERATION ❑REPAIR <br />~ <br />, <br />VALUATION OF WORK <br />MAIM AY <br />f iL�EA/IN'v <br />❑DEMOLISH <br />❑FENCE ❑SIGN ❑SWIMMING POOL <br />¢ <br />W <br />d <br />DESCRIBE WORK 1 m4m )m raw mum <br />2049 <br />PROPOSED USE <br />MECHANICAL <br />TY EOF FUEL ❑OIL UAB. ❑LPG. ELEC. <br />LEGAL JESC IT PT ION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES( <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS—H.P. EA. <br />LOT -- BLOCK —OF <br />REFRIGERATION UNITS—H.P. EA. <br />BOILERS—H.P. EA. <br />1 <br />_ <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />I <br />JOB ADDRESS <br />IFlI:� <br />WALL HEATERS—B.T.U. M <br />UNIT HEATERS—B.T.V. M <br />I <br />EVANORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGE HOOD <br />I <br />AIR HANDLING UNIT- C.F.M. <br />- <br />�, <br />TYPE Of FIXTURE OR ITEM <br />FEE <br />INCINERATOR <br />I <br />WATER CLOSET ITOILETI <br />f <br />BATHTUB <br />L AVATORV IWASH BASINI <br />-•-� <br />SHOWER <br />KITCHEN SINK d DISP. <br />SUB TOTAL f <br />I <br />DISHWASHER <br />PERMIT S <br />sism <br />LAUNDRY TRAY <br />TOTAL FEE SI <br />71W_ <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br />WATER HEATER <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PCRIOD OF 120 DAYS AT ANY TIME AFTER WORK 15 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 />URINAL <br />UN TAIN <br />DRINKING FOUN <br />FLOOR -SINK DRAIN <br />- <br />VACUUM BREAKERS <br />PROVISIONS OF LAWS AND ORDINANCES 13OVERNING TIIIS TYPE <br />ROOF DRAINS -RAIN LEADERS__ <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />DIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />SINK ISERVICF.-BAR ETC.) <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SUB TOTAL <br />PERMIT <br />f <br />TOTALFEE <br />f <br />I{ <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREETSETBACK <br />REAR YARD SETBACK <br />PLAN CDECK NUMBER <br />I14W <br />P NCHECKFEE <br />FEE RE IjeE PT NO <br />j_ _ <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />TYPE OF CONST. OCCUPANCY GROUP —60 OF UNITS DWELLING <br />1 <br />512E OF SLOG. NO. OF STORIES MAX. OCC. LOAD <br />BUILDING fOM—OM 30. W <br />PLUMBING 0� <br />_ <br />FIR�PONE 8A5 Ni FIRE REQUIREDSPRINKLERS <br />OYES ONO <br />MECHANICAL 7IW <br />SPECIAL CONDITIONS <br />------ <br />1 <br />OTHER 1 <br />PENELTY SEC. 3091n1 1 <br />TOTAL 01 Ice <br />— <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />AWLWATIONACCLFTE09Y PLAN501FCKUDBY AIVROVf Df0 ISSNANCFBY <br />*a eq <br />I <br />