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T/Ie Evergreen <br />CITY OF <br />everett <br />CITY MAIL 1SS IM <br />FVFIKD. VIASNIKGTOA <br />}S)n <br />°"' Of vItop R 1 BUILDING <br />CONSTRUCTION <br />PERMIT <br />MIX I]AN ICAI_ <br />everett <br />PLUMBING �.e <br />OWNER MAIL AOD,ILI,S LIP PEON) <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADORESS �PHO WE— LICENSE NO. <br />K <br />W <br />01 <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO, <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PERMIT <br />19BUILDING ❑ PLUMBING []MECHANICAL <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION �EPAIR <br />Z <br />F— <br />2 <br />VALUATIONOFWRDK <br />S <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOI <br />oc <br />d <br />DESCRIBE WORK TM _ <br />1852 <br />PROPOSED USE <br />MECHANICAL <br />TYPE <br />OF FUEL DOIL RAT, LPG. <br />GAS <br />ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />FOUR COPIES) <br />LOT BLOCK —OF <br />- - <br />JOB ADDRESS <br />A'� •'1� +� <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 />I <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />I <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />PLUMBING <br />-- <br />NO. TYPE OF FIXTURE OR ITEM _ _ FEE <br />WATER CLOSET (TOILET) 6 <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <br />I <br />AIR HANDLING UNIT— C.F.M. <br />INCINERATOR <br />I <br />BATHTUB <br />_ <br />LAVATORY <br />WASH BASINI <br />I <br />SHOWER <br />KITCHEN SINK & DISP. <br />SUBTOTAL S <br />1 <br />_ <br />DISHWASHER <br />PERMIT S <br />LAUNDRY TRAY <br />TOTAL FEE $ <br />I <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br />TION AUTHORIZED IS NOT COMMENCED WIT)/IN 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 />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PL.ICATION 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 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR —SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS—RAINLEADE RS <br />SINK (SERVICE —BAR ETC.) <br />SUB TOTAL <br />PERMIT <br />S <br />TOTAL FEE <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREETSETBACK <br />REAR YAROSETBACK <br />PLAN CHECK NUMOER <br />PLAN CHECK <br />FEE <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES [:)NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPA CV G OU <br />UNITED ELLING <br />BUILDING <br />5 <br />�� <br />SIZE OF BLDG. <br />NO. OF iORI S <br />MAX. CC. LOAD <br />PLUMBING <br />FIRS O <br />A NT <br />IR RI KL HS <br />RFOUIRED <br />DYES ❑NO <br />MECHANICAL <br />I <br />SPECIAL CONDITIONS <br />OTHER <br />1 <br />PENELTY <br />SEC. 300 (al <br />I <br />- <br />TOTAL <br />Jv <br />-- �-_- - <br />-- <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT <br />A <br />APPUCATIONACCFPTEO°V <br />PLANS(:NFCKED°Y APPIIOWO\FO <br />IAUANCERV <br />M Q� <br />