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the Evergreen <br />CITY OF CONSTRUCTION cAverett <br />everett PERMIT <br />CITY NAZI B$!AR$ <br />I YI RI II NA$NIR4i0M <br />NMI <br />['[,-I ""°""i""Y <br />nl vE lMA tBUILDING MECHANICAL PLUMBING �,e1 <br />OWNER MAIL ADDRESS lll' RR�e�L 1'�11G�RNe�E <br />ARCHITECT OR OESION R MAIL ADDRESS - PHONE LICENSE1+ <br />am <br />1 <br />1•�/�� <br />GENERAL CONTRACTOR MAIL ADORES, PHONE LICENSE NO. <br />MECH�AyN�IC�AL CONTRACTOR MAIL AOb HI'e: PHONE LICENSE NO. <br />P LUM B�INO CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. cc <br />W <br />i�aP m <br />PERMIT CLASS OF WORK � <br />Z <br />m BUIlDINO [#PIUMBINO =] MECHANICAL F <br />NEW []ADDITION ❑ALTERATION ❑REPAIR � <br />VALUATION OF WORK � <br />S � 0pEMDL1511 ❑FENCE ❑91ON ❑SWIMMING POOL d <br />DESCRIBE WORK //yyam� �'.eT ,$I/� 2591 <br />RJMe-J 8Yf$aA[ Ye�YY� iI� <br />PROPOSED USE MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY IS IIGW HE LOW OR ATTACH 7YP OF FUEL OIL GAS HAT. ❑LPG. ELEC. <br />FCUR�CO�PdIESI <br />LOT 23 �i BLOCK— OF PM- _Y �L,.r��r•,lz 'p- NO. TYPE OF EQUIPMENT FEE <br />AIR COND. UNITS-H.P. EA. S I <br />nn'' E �R REFRIGERATION UNITS-N.PflEFRIOE RATION UNITS-M.P. EA� <br />ATw �i�lr �� �d �7 � •�r ye A � � BOILERS-H.P. EA. I <br />GAS FIRED A.C. UNIT6-TONNAGE EA. <br />V L'tti iL_� FORCED AIR SYSTEMS-B.T.U. M EA. I <br />JOO ADDRESS eE�'R, e� WALL NE ATERS-B.T.U. M <br />«� "69 o `� � UNIT HEATERS-B.T.U. M I <br />EVAPORATIVE COOLERS <br />PLUMBING CLOTHES DRYERS 1 <br />VENTILATION FAN _ <br />RANGE HOOD I <br />NO. TYPE Of FIXTURE OR ITEM FEE AIR HANDLING UNIT- C.F.M. <br />WATER CLOSET (TOILET) $ —T- INCINERATOR 1 <br />BATHTUB <br />l AVATORV (WASH BASIN) 1 <br />SHOWER <br />KITCHEN SINK d DISP. SUBTOTAL K ITC HEN SINK $ <br />DISHWASHER � PERMIT S <br />LAUNDRY TRAY TOTAL FEE S <br />CLOTHES WAS,/ER _ THIS PERMIT BECOMES NULL AND VOID If WORK OR CONST RUC <br />WATER HEATER _ TION AUTHORIZED Is NOT COMMENCED WITHIN iZ0 DAYS, OR IF <br />URINAL CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />DRINKING FOUNTAIN PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />FLOOR -SINK OR DRAIN �— I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP <br />VACUUM BREAKERS__ PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />ROOF DRAINS-RAINLEADEflB �— PROVISION Of LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />SINK (SERVICE -OAR, ETC.) �— 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 />SUB TOTAL _ <br />PERMIT f <br />TOTAL FEE S �j/� � /� <br />SIGNATURE OFC eTA TOR OR AUTH. AGENT TE <br />SIDE YARD SETBACK STREET SETBACK REAR VARp SETBAC PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE, f�E LOT AREA VACANT ��f1Y� <br />1�' pvEs ONO FEES VALUATION FEE <br />TYPE OF CONST. OCCUPANCY GROUP UNITOS DWELLING /y� I <br />SI2 Fjp �eQFy«�' B 4Q�Q, O. OF STORIES MAX. OTC.LOAD BUILDING S Ee1F � /yW� <br />PLUMBING M/ <br />FIR 2 E UASLmENT Pl"tbrN I K <br />R FAO UI RED M. <br />LJVE9 ONO MECHANICAL co <br />SPECIAL CONDITIONS OTHER I <br />I <br />_ PENE ITv SEC. 3071e1 I <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />API'IICA i.ION ACCF4TF0 RY PI ANICNFCNEORY AMROYEO EB 10UARKE RY <br />a fra Ira <br />