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the Evergreen <br />CITY OF - <br />CONSTRUCTION evcrett <br />everett <br />PERMIT <br />City HALL ti9IM5 <br />IVIMIT. WASWMGI nN <br />AA)m <br />nl"nl Envr. <br />Zli' BUILDING <br />MLCI IAN <br />IC1AL PLUMBING <br />nFVF tb <br />,eOWN[.R <br />_, <br />ZIP Pl11'NI <br />ARCH I T ECTT pH DESIGNER MAIL ADDRESS <br />PHONE LICENSE IN, <br />GENERAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO <br />sr' T <br />MECHANICAL CONTRACTOR MAII ADDRESS <br />PHONE LICENSE NO <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />Uj <br />W <br />WO r <br />PERMIT <br />CLASS OF WORK <br />Z <br />q-BUILDING E]PLUMBINO ❑MECHANICAL <br />IJ ,a� <br />NEW <br />❑ADDITION ❑ALTEATION ❑REPAIR <br />R <br />♦_ <br />� <br />VALUATION OF WORK <br />$I1 /1fV '0 <br />❑DEMOLISH <br />[:]FENCE []SIGN ❑SWIMMING POOL <br />LU <br />DESCRIBE WORK <br />i� <br />PROPOSED USE <br />MECHANICAL <br />TYPE OF FUEL ❑OIL GASNAT. Lv&__0 ELEC. <br />LEGAL DESCRIPTION OF PROPERTY )SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />LOT �� BLOCK _OF_ I1T(i!!IaI)�. <br />nTr'1 <br />' <br />AIR COND. UNITS-H.P. EA. <br />S I <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />I <br />GAS FIRED A.C. UNITS- TONNAGE EA. <br />FORCED AIR SYSTEMS O.T.U. hi <br />1 <br />JOB ADDRESS <br />WALL HEATERS-B.T.U. M <br />ith Sty, J• -0 <br />UNIT HEATERSB.T.U. M <br />I <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAN <br />RANGEHOOO <br />I <br />AIR HANDLING UNIT- C.F.M. <br />!j <br />` <br />II <br />' <br />NO. <br />I TYPE OF FIXTURE OR ITEM <br />FEE <br />INCINERATOR <br />I <br />WATER CLOSET ITJILET) <br />S <br />i.JIBATHTUB <br />, <br />LAVATORY (WAS4 BASIN) <br />I <br />SHOWER <br />KITCHEN SINK 6 D'SP. <br />SUB TOTAL S <br />I <br />DISHWASHER <br />PERMIT S <br />_ <br />LAUNDRYTRAY <br />TOTALFEE $ <br />I <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUG <br />WATER HEATER <br />URINAL <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 />DRINKING FOUNTAIN <br />_ <br />FLOOR -SINK OR DRAIN <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 />VACUUM BREAKERS <br />ROOF GRAINS-RAINLEADE RB <br />SINK MERVICE-BAR, ETC.) <br />OR NOT, THE GRANTING OF A PCRMIT DOES NOT PRESUME TO <br />GIVE: AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />- <br />r.NY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SUR TOTAL <br />---- PERMIT <br />S <br />TOTAL FEE <br />S <br />Jqy s. -.A Q 1 i <br />ACTOR E <br />SI NAEOf CUNT FACTOR OR AUTN. AGENT DA <br />SIDE. YARD SETBACK <br />STREETSETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />i � � � <br />" ii- <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />,A <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. OCCU ANCY GROUP NO. OSF DWELLING <br />1 SIZE OF BLOG. NO.OF STORIES MA%. OCC. LOAD <br />BUILDING S ) my n•Cil ]G]_� N) <br />PLUMBING <br />I; FIRE ZONE BAS NT "HESPKINKLERS <br />REQUIRED <br />DYES ONO <br />MECHANICAL <br />SPECIAL CONDITIONS; <br />OTHER I <br />1 <br />PENELTY SEC. 303 (a) 1 <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />ICAH0NACCFPTEOAY PI ANi LIi[C%EU lY. AMPOVFU lU ISSUANCE BY <br />r <br />B <br />