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the Evergreen <br />CITYOF CONSTRUCTION everctt <br />everett PERMIT <br />CITYMAIL ra Fen <br />FVIRETT, WASHIRGIRH <br />SN°I <br />"'°' °OEVELO BUILDING MECHANICAL FTUMIiING <br />,;„ ,e <br />OWNER MAIL ADDRESS tit' I'HUN1. <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE + LICENSE NO 7-4- <br />^rut 40 as"r-0 5- i <br />_ <br />GENERAL CONTRACTOR MAIL ADORE S PHONE LICENSE NO. <br />:4nr� <br />vto emok%mm "Jt+" lta4wr`YCX�'# <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. cc <br />W <br />m <br />PERMIT CLASS OF WORK <br />Z <br />TIBUILDING ❑ PLUMBING []MECHANICAL H <br />❑NEW ❑ADDITION qhALTE RATION ❑REPAIR � <br />VALUATION OF WORK cc <br />❑DEMOLISH []FENCE ❑SIGN ❑SWIMMING POOL <br />! 1 <br />DESCRIBE WORK <br />ttia7aaa onvat trAo gala a 1703 <br />PROPOSED USE MECHANICAL <br />TYPIEOFFUEL OIL NAT. LPG. ELEC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH GAS <br />FOUR COPIES) <br />LOT BLOCK_OF -. __._.— NO. TYPE OF EQUIPMENT FEE <br />AIR COND. UNITS-H.P. EA. ! 1 <br />�({IL/�� at tj* I 4 Met ot BOILEREFRRS pH P!EA UNITE-H.P. EA. <br />GAS FIRED A . UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS- B.T.U. M EA. I <br />JOB ADDRESS <br />WALL )/EATERS-R.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />EVAPORATIVE COOLERS <br />PLUMBING <br />CLOTHES DRYERS <br />I <br />VENTILATION FAN <br />RANGEHOOD <br />I <br />i <br />AIR HANDLING UNIT- C.F.M. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />! <br />INCINERATOR <br />I <br />BATHTUB <br />LAVATORY IWASH BASIN) <br />I <br />_ <br />SHOWER <br />_ <br />KITCHEN SINK 6 DISP. <br />SUB TOTAL S <br />I <br />_ <br />DISHWASHER <br />PERMIT ! <br />LAUNDRY TRAY <br />TOTALFEE ! <br />I <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />WATER HEATER <br />URINAL <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />I <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />I HEREBY CERTIFY THAT I 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 DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR ETC.) <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 />SUB TOTAL <br />PERMIT f <br />TOTAL FEE ! <br />I•��A.�IG <br />_ <br />SIGNATURE OF CONTRACTOR OR AUTH. AGENT DATE <br />SIDE YARD SETBACK <br />STREETSETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF DWELLING <br />UNITS 1 <br />SIZE OF BLOG. NO. OF STORIES AX, BCC. LOAD BUILDING <br />_ PLUMBING 1 <br />FIR ZONE BA .NT 1 INKL S _ <br />REQUIRED <br />OYES ONO MECHANICAL I <br />SPECIAL CONDITIONSOTHER <br />---- PENELTY SEC. 3031W) 1 <br />TOTAL <br />PERMIT VALIDATION <br />- WHEN PROPERLY VALIDATED (IN THISSPACE) THIS IS YOUR PERMIT <br />APPLIUTION ACCEPTED BY PLANS CHFCKFD BY. APPROVED FOA IMARCE R♦ <br />w <br />I <br />0 <br />