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the Evergreen <br /> CITY OF CONSTRUCTION everett <br /> everett PERMIT <br /> xntl "^ALAS <br /> 'I N111 11!!',x'Al ON <br /> "'O1 <br /> DINT OI COMMUNITY BUILDING MECHANICAL PLUMBING e <br /> O[YILOIM(NT <br /> MAIL ADORESS ZIP PHONE <br /> OWNER AIL <br /> yyy, <br /> 'fiBLBOY * TA/YN/ LICENSE NU �7 A <br /> ARCHITECT OR DESIGNER <br /> MAIL ADDRESS PHONE <br /> GENERAL CONTRACTOR <br /> MAIL ADDRESS PHONE LICENSE NO. <br /> MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br /> cc <br /> ADDRESS PHONE <br /> LICENSE NO. W <br /> PLUMBING CONTRACTOR MAIL G] <br /> PERMIT CLASS OF WORK Z <br /> H <br /> ❑BUILDING ❑PLUMBING MECHANICAL ❑NEW ❑ADDITION []ALTERATION ❑REPAIR <br /> - G: <br /> VALUATION OF WORKLU <br /> ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL a <br /> f - - - <br /> DESCRIBE WORK 2201 <br /> 1lt uin riro-cab !lrvis acc ^ slla 2i I�QU!T'O <br /> PROPOSED USE MECHANICAL <br /> too TV EO F'J L OIL GAS. LPG. <br /> ELEC. <br /> FECIAL OUR COPIES) TYPE <br /> OF PROPERTY ISHOW BELOW OR ATTACH <br /> N0. TYPE OF EQUIPMENT FEE <br /> LOT BLOCK--OF AIR GOND.UNITS-H.P.EA. S I <br /> REFRIGERATION UNITS-H.P. EA. <br /> BOILERS-H.P.EA. I <br /> GAS FIRED A.C. UNITS-TONNAGE EA. <br /> FORCED AIR SYSTEMS-B.T.U. MEA. I <br /> JOB ADDRESS WALL HEATERS-B.T.U. M <br /> UNIT HEATERS-B.T.U. M I <br /> r~ EVAPORATIVE COOLERS <br /> PLUMBING CLOTHES DRYERS I <br /> VENTILATION FAN <br /> RANGE HOOD I <br /> AIR HANDLING UNIT- C.F.M. k <br /> NO. TYPE OF FIXTURE OR ITEM FEE INCINE ATOR I <br /> WATER CLOSET(TOILET) _ f <br /> BATHTUB I <br /> LAVATORY WASH BASIN) <br /> SHOWER SUBTOTAL $ <br /> 1 <br /> K ITCHE N SINKd DISP. PERMIT 6 <br /> DISHWASHER <br /> LAUNDRY TRAY TOTAL FEE S 1 <br /> uw <br /> CLOTHES WASHER rPERIOD <br /> RMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- <br /> WATER HEATER UTHORIZED 18 NOT COMMENCED WITIIIN 120 DAYS,OR IF <br /> RUCTION OR WORK 19 SUSPENDED OR ABANDONED FOR A <br /> URINAL OF 170 DAYS AT ANY TIME AFTER WORN I6 COMMENCED. <br /> D RINK)NO FOUNTAIN BY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br /> FLOOR-SINK OR DRAIN ION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> VACUUMBREAKERS IONS OF LAWS AND ORDINANCE6 GOVERNING THIS TYPE <br /> ROOF ORAINS-RAINLEADERS RK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> SINK ISERVICE-OAR ETC.) T, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> UTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> NY OTH'A STATE OR I <br /> PERFORMANCE OF CONSTRUCTION.LOCAL LAW GATIN6 CONSTRUCTION <br /> 9V8 TOTAL <br /> PERMIT f <br /> TOTAL FEE S j,/}I'j'r <br /> SIGNATURE OF CONTRACTOR"AUTH.AGENT DATE <br /> 910E YARD SETBACK STREET SETBACK REAR VARO SE TB AC PLAN CHECK FEE PLAN CHECK NUMBER FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE <br /> OYES ONO FEES VALUATION FEE <br /> TYPE OF CONST. OCCUPANCY GROUP UNITS DWELLING I <br /> I <br /> SIZE OF BLDG. NO.OF STORIES AX.OCC. LOAD BUILDING <br /> f I <br /> I <br /> _ _ PLUMBING <br /> TIME ZONE BAS T gEOUIREOK RS IM <br /> OYES ONO MECHANICAL 15 Fn/ <br /> 1 <br /> AIPECIAL CONDI t ONS: OTHER I <br /> PENELTY SEC. 303 111) I <br /> I <br /> TOTAL <br /> -- PERMITVALIDATION <br /> WHEN PROPERLY VALIDATED LIN THIS SPACE)THIS IS YOUR PERMIT <br /> AMnOVFOFU ISSIIAK[BY <br /> MYYICATIONA0.[I'l1UHY PI ANS CNFCN[R BY �p <br /> 0 <br />