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the Evergreen <br />CITY OF CONSTRUCTION everett <br />everett PERMIT <br />CITY "ALL 7»81115 <br />EVE RETT. WASHINGTON <br />WT01 <br />"'°'R'CONVVNIIT V BUILDING MECHANICAL PLUMBING <br />OIVRONVU <br />,eOWNER <br />MAIL ADDRESS ZIP PIIONE <br />R&RUlf IJWk4rl = <br />3(lj%�iG <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />MECHANICAL ADDRESS LICENSE NO. <br />�CONTRACTOR <br />�/I may. 'MAIL <br />�y •�p� .��IL�1���PHONE <br />�y� <br />Pum flm?m •AID rr, ift � w. 4Lr V(.L=m sea <br />I'LUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />LU <br />m <br />PERMIT <br />CLASS OF WORK <br />Z <br />❑ BUILDING ❑ PLUMBING K] MECHANICAL <br />�NEW ❑AbDITION ❑ALTERATION ❑REPAIR <br />F- <br />2 <br />VALUATION OF WORK <br />III <br />DEMOLISH [:)FENCE ❑SIGN ❑SWIMMING POOL <br />cc <br />1 <br />DESCRIBE WORK <br />1767 <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL ❑OIL GA5 LPG. ❑ ELEC. <br />I EGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />I OUR COPIES) <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />LOT BLOCK_0. <br />AIR COND. UNITS-H.P. EA. <br />.- <br />S 1 <br />REFRIGERATION UNITS-H.P. EA. <br />--~- <br />BOILERS-H.P. EA. <br />I <br />- <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />_ <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />JOB ADDRESS •01\! IL�� per_ �L_ <br />WALL HEATERS-B.T.U. M <br />T <br />UNIT HEATERS-B.T U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />_ <br />CLOTHES DRYERS <br />I <br />_ <br />VENTILATION FAN <br />_ <br />RANGEHOOD <br />I <br />,t <br />N_O, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M.. <br />WATER CLOSET(TOILETI <br />: <br />_ <br />INCINERATOR <br />I <br />BATHTUB <br />LAVATORY IWASH BASIN) <br />I <br />SHOWER <br />_ <br />KITCHEN SINK 6 DISP. <br />SUBTOTAL S <br />DISHWASHER <br />PERMIT S <br />4V <br />LAUNDRY TRAY <br />TOTAL FEE S <br />CLOTHES WASHER <br />WATER HEATER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />URINAL <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAME TO BE T RUE 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 />VACUUM BREAKERS <br />ROOF DRAINS-RAINLL <br />A_DF RS <br />SINK (SERVICE-aAR`E'�r,.) <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 />SUO IViAL <br />1 <br />_ <br />PERMIT <br />S <br />TOTAL FEE <br />S <br />��RNE' <br />X a d" 29*k <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />SIOEYARDSETBACK <br />STREETSETBACK <br />REARYAROSETBACK <br />PLAN CHECK NUMBER <br />PLANCHECKFEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. OCCUPANCY GROUP Os DWELLING <br />NO. <br />NITI <br />SIZE OF SLOG. NO. OF STORIES MAX. OCC. LOAD BUILDING S 1 <br />I <br />PLUMBING <br />I IRE ZONE BASEMENT PIRkSPRINKL RS <br />REQUIRED <br />OYES ONO MECHANICAL <br />SPFCIAL CONDITIONS - _ OTHER <br />- PBNELTY SEC. 000(N 1 <br />-- TOTAL p j� <br />PERMIT VALIDATION <br />-- - - WHEN PROPERLY VALIDATED I IN THIS SPACE) THIS IS YOUR PERMIT <br />"I'IICATIONACCEPT(BRY 11POR°VF0 L0 ISSUdN[:F BY <br />1pLAN5CHU`kU)0V <br />Q <br />