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the Evergreen <br />CITY OF CONSTRUCTION cverelt <br />everett PERMIT <br />City HAG IS'RUS <br />f VE III 1I. WAEHINGIBN <br />lINI <br />°"'°ICRN%HnIIYnl BUILDING MECHANICAL PLUMBING <br />ofvuoRK[ <br />OWNER MAIL ADDRESS LI' I.00NL <br />3 "I'm L <br />ARCHITECT OR DESIGNER- MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS NONE LICENSE NO. <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE - LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS-f'i/pN[ LICENSE NO. <br />LU <br />rrma <br />m <br />PERMIT CLASS OF WORK - - - <br />❑ BUILDING M PLUMBING []MECHANICAL <br />❑NEW ❑ADDITION ❑ALTEpATION 11REPAIR <br />Z <br />~ <br />t <br />VALUATION OF WORK <br />E <br />(I DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />LU <br />a <br />DESCRIBE WORK <br />- <br />%-2- <br />7/ <br />PROPOSED USE <br />MECHANICAL <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES( <br />TY E OF FUEL. OIL HAT. LPG. ELEC, <br />GAS <br />LOT BLOCK _ OF— <br />NO. <br />TYPE OF EQUIPMENTFFAIR <br />COND. UNITS-H.P. EA. <br />REFRIGERATION UNITS-H.P. EA.BOILERS-H.P. <br />EA.GAS <br />FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA.JOB <br />ADDRESS M• wE_ah :u <br />FU Yl <br />WALL HEATERS-8.T.U. MLY <br />UNIT HEATERS-B.T.U. M <br />PLUMBING — <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAN <br />RANGEHOOD <br />I <br />,E <br />N <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />WATER CI,OSET ITOILETI <br />E <br />INCINERATOR <br />1 <br />I• <br />BATHTUB <br />LAVATORI(WASH BASIN) <br />1 <br />SHOWER <br />+_- <br />KITCHEN SINK 6 DISP, <br />SUBTOTAL E <br />DISHWASHER <br />- PERMIT f <br />— <br />LAUNDRY TRAY <br />_ <br />TOTAL FEE S <br />1 <br />CLOTHES WASHER <br />WATER HEATER <br />- <br />115 PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />iON AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />INSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />' MOO OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />-ILREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />I iCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />"0VISIONS 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 />'VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />vY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />H THE PERFORMANCE OF CONSTRUCTION. <br />VACUUM BREAKERS <br />- <br />ROOF DRAINS-RAINLEADERS <br />- 1 <br />SINK (SERVICE -BAR, ETC.) <br />"- <br />- —{ --- <br />SUB TOTAL <br />- <br />PERMIT f <br />TOTAL FEE E <br />X <br />SIGNATUREOF CONTRACTOROR AUTH. AGENT DATE <br />SIDE YAf1DSETBACK <br />STREET SETBACK <br />REAR YARD SETBACX <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO.OF OW E LUNG <br />UNITS <br />-- <br />1 <br />BUILDING <br />S <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUM81NO <br />_ <br />nla' <br />FIREN <br />BASEM T <br />S RI KL RS <br />Rr <br />❑VESYES ONO <br />MECHANICAL <br />{ <br />OTHER <br />SPECIAL CONDITIONS: <br />1 <br />1 <br />PENELTY <br />SEC. 003 IS) <br />I <br />_ I <br />- -- <br />TOTAL <br />PERMIT VALIDATION <br />- WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS IS YOUR PERMIT <br />11AIHINACEJPIIIIRv UNS11M.E00v AMROVFDF° ISSUAKK(BY <br />L o• <br />1p <br />o <br />