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the Evergreen <br />CITY OF <br />everett <br />1 uY HALL 9591115 <br />I VI RI II, NAINING'°N <br />911A- <br />0IV °,VELOPMf MI BUILDING <br />CONSTRUCTION <br />PERMIT <br />MLCIIANICAL. <br />everett <br />PLUMBING <br />OWNER MAIL <br />/�� �t -` y MAIL ADDRESS ZIP PHONL <br />v= 11 N VM 14th 5TM <br />20104 <br />ARCHITECT OR DESIGNER MAIL ADDRESS IIONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />QA1a' <br />cc <br />m <br />PERMIT <br />❑ BUILDING PLUMBING ❑MECHANICAL <br />CLASS OF WORK <br />f <br />LJ NEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />Z <br />� <br />VALUATION OF WORK <br />f <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />cc <br />W <br />D. <br />DESCRIBE WORK <br />1193 <br />PROPOSED USE <br />MECHANICAL <br />TYPE Or FUEL ❑OIL HAT. LPG. ELEC. <br />OAS <br />FOUR COPSESIIPTION OF PROPERTY ISHOW BELOW OR ATTACH <br />LOT BLOCK —OF <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />S I <br />REFRIGERATION UNITS-H.P. EA. <br />BOILERS-H.P. EA. <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />1 <br />JOB ADDRESS �� fVw <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />1 <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <br />1 <br />O. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />WATER CLOSET (TOILET) <br />f <br />INCINERAIOR _ <br />I <br />BATHTUB <br />LAVATORY WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />SUE TOTAL Si <br />DISHWASHER <br />PERMIT $ <br />LAUNDRY TRAY <br />TOTALFEE f <br />) <br />CLOTHES WASHER <br />WATER HEATER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 170 DAYS. OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOn A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMEr,l <br />I HEREBY CERTIFY TI4AT 1 HAVE READ AND EXAMINED Tlu ... <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECt, nl 1 <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYP, <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 CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />UI INAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR ETC.) <br />4 <br />6U8 TOTAL <br />S <br />f <br />_ PERMIT <br />TOTAL FEE <br />SIGNATURE OF CONT RACTOROR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETRAC <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />',I ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />�! OF CONST. <br />OCCUPANCY GROUP NO. <br />UNITS <br />OF DWELLING <br />I <br />BUILDING <br />S <br />OF BLDG. <br />NO. OF STORIES <br />VAX.00C. LOAD <br />PLUMBING <br />1� <br />I IRL ON <br />BAS NT <br />REOUI <br />IR RI 1 L. <br />RED <br />OYES ONO <br />MECHANICAL <br />) <br />SPECIAL CONDITIONS <br />— <br />OTHER <br />1 <br />- <br />PENELTY <br />SEC. 0001N) <br />I <br />TOTAL <br />v �� <br />-— <br />'ERMIT VALIDATION <br />NHEN PROPERLY VAL IOAI ED IIN TI/IS SPACEI THIS IS YOUR PERMIT <br />