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the Evergreen <br />CITY OF <br />everett <br />DIY HALL nsms <br />IVERID. WASHINGTON <br />9RIal <br />DIPI or COMMUNITY BUILDING <br />ntvHaPMINI <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING e� <br />OWNER MAIL ADDRESS ZIP PHONE <br />writ comb. co, "3 n ft m Aw Ro o <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE MIN NO. <br />w���� <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSENO. <br />fts wr_uro_ m <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />iA <br />PERMIT CLASS OF WORK <br />nBUILOIN6PLUMBING ❑MECHANICAL tNEW ❑ADDITION ❑ALTERATION ❑REPAIR <br />O <br />W <br />z <br />~ <br />VALUATION OF WORK <br />❑DEMOLISH ❑FENCE [)SIGN ❑SWIMMING POOL <br />W <br />12O O O O <br />DESCRIBE WORK <br />PROPOSED USE <br />MECHANICAL <br />TY E OF FUEL OIL NAT. LPD. ELEC. <br />OAS <br />'- <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH <br />FOU PISESI iO ! �'T <br />iV �i . % <br />LOT BLOCK, OF <br />NO. <br />TYPEEQUIPMENT <br />FEE <br />AIR CDND, UNITS-H.P. EA. <br />S I <br />REFRIGERATION UNITS-M.P. EA. <br />BOILERS-H.P. EA. <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />1 <br />JOB ADDRESS <br />so Oft "w hvwmtt <br />WALL HEATERS-B.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 />AIR HANDLING UNIT- C.F.M. <br />TYPE OF FIXTURE OR ITEM <br />F <br />f <br />INCINERATOR <br />I <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I - -- <br />SHOWER <br />— -- <br />KITCHEN SINK d DISP. <br />SUBTOTAL f <br />I _ <br />DISHWASHER <br />PERMIT IF <br />LAUNDRY TRAY <br />TOTAL FEE S <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 />CONSTRUCTION OR WQRK IS SUSPENDED OR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK 15 COMMENCED. <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 />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 REGULATINO CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />WATER HEATER <br />URINAL <br />DRINKING FOUNT'.IN <br />FLOOR -SINK C•H DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK ISE RVICE-BAR ETC.) <br />SUB TOTAL <br />PERMIT <br />f <br />TOTAL FEE <br />f <br />SIGNATURE OF CONTRACTOROR AUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARDSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE _ <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />OW LLING <br />UNO NITS <br />I <br />I <br />Clut0) <br />I <br />I <br />I <br />I <br />BUILDING <br />f <br />SIZE OF flLDO. <br />NO. OF STORIES <br />MA%.00C. LOAD <br />PLUMBING <br />FIRE ZONEBASEMENT <br />RF.OUIREDK S <br />DYES ONO <br />MECHANICAL <br />SPECIAL CONDITIONS: <br />OTHER <br />PENELTY <br />SEC. 003 IN) <br />TOTAL1 <br />— — <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 19 YOUR PERMIT <br />a <br />FITUcRl10 EPTEDSY. lPLAfWfCKf0" <br />APPRDVF��D�SSUANC[DY <br />