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the Evergreen <br />CITY OF <br />eve rett <br />CnY KALI III INS <br />[VERETT. wA{NINGTnN <br />NMI <br />OVT P,V1INPNrtY BUILDING <br />III VI I DPNI NI <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING <br />e <br />OWNER MAIL ADDRESS :.1P PI O <br />� a. In"' I an 73"4o <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE tICLNSL NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE - 1. ICE NSE NO. <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT CLASS OF WORK <br />[BUILDING ❑PLUMBING []MECHANICAL <br />❑NEW ❑ADDITION IIALTFRATION ❑REPAIR <br />L17-'CT <br />/ /Q� <br />CC <br />W <br />m <br />z <br />F- <br />� <br />�'ALV ATION OF WORK <br />$ ow <br />Cl DEMOLISH ❑rFNCE ❑SIGN []SWIMMING POOL <br />cc <br />W <br />0 <br />_ 320 <br />�LBI� <br />DESCRIBE WORK WIE fi`1 C&vMT IM a..PCjp <br />PROPOSED USE <br />MECHANICAL <br />7 YPE Of FUEL QOIL QNAT. LPG. ❑ELEC <br />GAS <br />LEG�AL DESEgRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOULOT BLOCK_OF "MM <br />NO. <br />TYPE OF EQUIPMENT rrF <br />AIR COND. UNITS- H.P. EA, f <br />REFRIGERATION UNITS-H.P. EA. <br />T <br />BOILERS-H.P. EA. <br />GAS FIRED A.C. UNITII-TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />I <br />JOB ADDRESS <br />WAI L HLATERS R.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <br />1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />WATER CLOSET (TOILET) <br />S <br />INCINERATOR <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />- <br />- <br />_ <br />_ <br />KITCHEN SINK Be DISP. <br />SUB TOTAL f <br />DISHWASHER <br />PERMIT S <br />LAUNDRY TRAY <br />TOTAL FEE S <br />CLOTHESWASHER <br />-- <br />_ <br />_ <br />- <br />WATER HEATER <br />"IFS PERMIT BECOMES NUL L 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 />I PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEU. <br />HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP <br />Pt ]CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALI <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 CONSTRUCTIO14 <br />OR THE PERFO RMANr'E OF CONSTRUCTION. <br />r/ <br />x <br />URINAL <br />�— <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR GRAIN <br />VACUUM BREAKERS <br />�— <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR ETC.) <br />SUBTOTAL <br />— <br />PERMIT <br />f <br />TOTALFEE <br />f <br />- <br />SIGNATUREOI <br />CONTRACTOROR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREETSETBACK <br />REAR YARD SETBACP <br />PLAN CHOCK UMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑vefi ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />WO.OF DWELLING <br />UNITS <br />—� <br />II <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />BUILDING <br />/y�Iy <br />S �VYy1/1/ <br />5 00 <br />PLUMBING <br />I <br />FIRE O <br />BAS <br />FIR S RI Kl 8 <br />R DYES <br />YES ONO <br />MECHANICAL <br />I <br />SPECIAL CONDITIONS-. <br />OTHER <br />I <br />I <br />PENELTY <br />SEC. 0031PI <br />1 <br />1 <br />- <br />TOTAL <br />_ <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PE RMII <br />A <br />- l'PIIrATIDNACCFPTII BY <br />PUNS CIIIf.N[n PY ♦PPRDYFD <br />rp ISSUANCE BY <br />r� p� <br />