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the Evergreen <br />CITY OF <br />everett <br />CITY HALL PH IRS <br />FWAITT. WASHINGtOM <br />94"1 <br />0[II or COMMUNITY <br />GFV4MUNIBUILDING <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING <br />CItR IL ADDRESSPHONE Aft ftofttm <br />=111 <br />l3s"my <br />�IMfS_ aZ�� <br />fn+ri6 <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />PHL'Nt LICENSE NO. <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />P11 LICENSE NO, <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />PHONE LICENSE NO. <br />W <br />m <br />PERMIT <br />[]BUILDING ❑ PLUMBING []MECHANICAL <br />CLASS OF WORK <br />❑NEW <br />❑ADDITION ❑ALTERATION ❑REPAIR <br />Z <br />= <br />V ALUA FION OF WORK <br />$9301110❑DEMOLISH <br />&FENCE ❑SIGN ❑SWIMMING POOL <br />W <br />a <br />f`ESCRIBE WORK <br />vmb Sam <br />-- <br />1 <br />201 <br />^ROPOSED USE <br />MECHANICAL <br />I EGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />I o las EST <br />Lo BLOCKM OF A <br />TYPE OFTUE L ELEC. <br />OIL ❑OGAS LPG. AT. <br />Q❑ <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />i 1 <br />REFRIGERATION UNITS- H.P. EA. <br />- -- <br />BOILERS-H.P. EA. <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />WALL HEATERS-B.T.U. M <br />I <br />JOB ADD P✓* <br />PLUMBING <br />UNIT HEA'FRS-B.T.U. M <br />EVAPORATIVE COOLERS <br />I <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAN <br />RANGE HOOD <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />I <br />WATER CLOSET (TOILET) <br />BATHTUB <br />$ <br />INCINERATOR <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK IS DISP. <br />SUB TOTAL i <br />DISHWASHER <br />PERMIT i <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />TOTAL FEE f <br />1 <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 />CONSTRUC. ,JN OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICAT ION 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 />OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORTV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER S� ATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF COI+STRUCTION. <br />_�/�rg�-y` <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR ORAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />PERMIT f <br />TOTf.L FEE i <br />SIGNATURE OF CONTRACTOROR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YAROSETRACH <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CO NST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING <br />UNITS <br />1 <br />SIZE OF SLOG. <br />NO. OF STORIES <br />VAX. OCC. LOAD <br />BUILDING <br />i <br />PLUMBING <br />1 <br />FIR ON <br />BAS M NT <br />I I K S <br />REQUIRED <br />❑YES ONO <br />MECHANICAL <br />I <br />SPECIAL CONDITIONS'. <br />OTHER <br />I <br />PENELTY <br />SEC. 200 (a) <br />I <br />- -- <br />- <br />TOTAL <br />Poo I <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN T14ISSPACEI THIS IS YOUR PERMIT <br />Y <br />— <br />MLIWTI %CEPTEa BV <br />m4pull <br />PI,LNS CHECKED By <br />AMMOVIDPo ISSunNCf lv <br />:�Cr <br />