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the Evergreen <br />CFI Of OF <br />everett <br />Cm HAIL 251 IY1 <br />IVIBITT. WASHINGTOB <br />99201 <br />nV2 BT CBHMHNpY BUILDING <br />n1VHnPMT NI <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING �e <br />OWNER MAIL ADDRESS ZIP PHONE <br />lTelmt PAl A 2ORi T�e4 9OQct� 49"ift _ <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 MAIL ADDRESS PHDNI LICENSE NO. <br />P1: RMIT CLASS OF WORK <br />)g,,yy <br />BUILDING ❑ PLUMBING ❑ MECHANICAL <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />9j3-n: <br />D: <br />W <br />no <br />C <br />Z <br />~ <br />2 <br />VALUATION Qf.AOUL <br />{A <br />S <br />❑DEMOLISH [if ENCE ❑SIGN ❑SWIMMING POOL <br />cc <br />W <br />IL <br />DESCRIBE WORK COMM <br />l9iRR':' � i%�'R. RP.II'1 � [''iT�Z':j <br />e <br />O v <br />PROPOSED USE <br />MECHANICAL <br />TYPE <br />OF FUEL DOIL NAT. LPG. <br />❑ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />» at <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S 1 <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />I <br />OAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS- B.T.U. M EA, <br />I <br />JOB ADDRESS ��1�yyy <br />III=M <br />� S� <br />WALL HEATERS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />I <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />1 <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 />f <br />BATHTUB <br />LAVATORY WASHBASIN) <br />SHOWER <br />KITCHEN SINK & DISP. <br />SUB TOTAL S <br />I <br />DISHWASHER <br />PERMIT S <br />LAUNDRY TRAY <br />TOTAL FEE S <br />I <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUE. <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 />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 OTIOES STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION, <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR GRAIN <br />VACUUM BREAKERS <br />ROOF GRAINS-RAINLEAOERS <br />SINK ISERVICE-BAR ETC.) <br />SUBTOTAL <br />PERMIT <br />f <br />TOTAL FEE <br />SIGNATURE OF CONTRACTOROR AUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REARYARDBETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />hFO UNIO9 COW LL-IN O <br />1 <br />BUILDING <br />M <br />J fAI <br />SIZE OF BLDG. <br />NO. OF STORI S <br />MAK.00C. LOAD <br />PLUMBING <br />FINE ZONE <br />GAS M NIT <br />FIRE SPRINKLERS <br />RIFOUIRED <br />DYES ❑NO <br />MECHANICAL <br />I <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />PENELTY <br />SEC. 30]1n) <br />I <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ION THIS SPACE) THIS 15 YOUR PERMIT <br />0 <br />AHVI )CATION I1ClIM[ O BY <br />PLANSCHICk1I1BY <br />APPPOVf0 f01 IS.UANCF BY <br />2�a <br />