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the Evergreen <br />CItYOr CONSTRUCTION evercLtl <br />everett PERMIT <br />i1It IAt, <br />I VI NI II wAV',IiM FInY <br />91:01 <br />nfvr PIIIc�t CPU h i BUILDING MECHANICAL PLUMBING <br />OWNER MAILA,DDRESS + :jl�+. PHUNE <br />awlto ISMA/atrand ' tisetsa�` wm= <br />ARCHITECT OH DESIGNER AI RESS PHONE LICENSE Pr <br />.� <br />�1�7( <br />OENEPAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NI' <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />LU <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />r <br />W <br />00 <br />PERMIT <br />[]BUILDING [PLUMBING []MECHANICAL <br />CLASS OF WORK <br />NEW ❑ADDITION [I ALTERATION ❑REPAIR <br />� <br />Z <br />F <br />g <br />VALUATION OF WORK <br />S <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />It <br />W <br />a <br />DESCRIBE WORK <br />1 5 y 1 <br />PROPOSED USE <br />MECHANICAL <br />TY E OF FUEL ❑OIL HAT. LAD. ELEC. <br />GAS <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />NO. <br />TYPE OF EQUIPMENT <br />AIR COND. UNITS-H.P. EA. <br />REFRIGERATIONUNITS-H.P. EA. <br />BOILERS-H.P. EA.GAS <br />FIRED A.C. UNITS -TONNAGE EA.FORCED <br />AIR SYSTEMS-B.T.U. M EA.JOB <br />ADDRESS•.�/ <br />X 'i� 1: <br />WALL HEATERS--B.T.U. M <br />E <br />UNIT HEATERS-O.T.U. MEVAPORATIVE <br />PLUMBING <br />COOLERS <br />CLOTHES DRYERSVENTILATION <br />FAN <br />RANGE HOOD <br />AIR HANDLING UNIT- C.F.M. <br />TYPE OF FIXTURE OR ITEM <br />F E <br />INCINERATOR <br />I <br />WATER CLOSET (TOILET) <br />f <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />1 <br />SHOWER <br />KITCHEN SINK d DISP. <br />SUBTOTAL $ <br />1 <br />DISHWASHER <br />PERMIT S <br />LAUNDRY TRAY <br />TOTALFEE S <br />_ <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 />PFRIOO OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED, <br />"E REBY CERTIFY THAT 1 I4AVE READ AND EXAMINED THIS AP <br />iCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AU. <br />- )VISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />,IVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />x <br />SIGNATURE OF CONTRACTORORAUTH.AGENT GATE <br />WATER HEATER <br />URINAL <br />I - <br />DRINKING FOUNTAIN <br />-- I <br />— 1-- -- <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RA114LEADERS_ <br />SINK (SERVICE -BAR ETC.) <br />SUB TOTAL <br />PERMIT <br />f <br />_ <br />TOTAL FEE <br />$ <br />SIDEYAROSETBACK <br />STREETSETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF OWE LUNG <br />UNITS <br />1 <br />BUILDING <br />i <br />I <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />291 00 <br />FIRE ON <br />BASEMENT <br />S RI K PS <br />REQUIRED <br />[]YES ONO <br />MECHANICAL <br />1 <br />SPECIAL CONDITIONS: <br />OTHER <br />I <br />I <br />PENELTY <br />SEC. 3031K) <br />I <br />TOTAL <br />29100 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />AIw LIU110N ACCLPHI)PY PIANSCHECKEP PY AR'POVfOfO IiT11ANC[PY <br />r+ <br />o <br />