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the Evergreen <br />CITY OF <br />eve rett <br />CItY HALL ISSIre <br />FVFNFTt. BSLII\C!BN <br />""I <br />DtPi or WNNUNHY BUILDING <br />DFVILDPNt NI <br />CONSTRUCTION <br />PERMIT <br />MECHANICAL <br />everett <br />PLUMBING �e� <br />OWNER MAIL AUUHLSS Z11' I•nUNI <br />vut r=W* Mo. Me 9530 8 fir AW a svwm 9c= <br />A CHIT CTOR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />loh <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />lee,77 <br />LU <br />PLUMBING ONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />M�`� <br />i <br />W <br />PERMIT <br />aBUILDING QPLUMBING MMECHANICAL <br />CLASS OF WORK <br />❑ NEW (=ADDITION ❑ALTERATION ❑REPAIR <br />Z <br />~ <br />VALUATION OF WORK <br />f �(� <br />❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING POOL <br />D- <br />LU <br />DESCRIBE WORK Aw.,nm TO ?TTle , , xI cr & Swp aulloo <br />195 5 <br />PROPOSED USE <br />MECHANICAL <br />TY E OF FUEL OIL NAT. LPG. ELEC. <br />GAS <br />— <br />LEGAL OEEEESC RIPT ION OF PROPERTY (SHOW BELOW OR ATTACH <br />LOT eI � <br />l0T BLOCK —OF <br />TYPE O <br />FEE <br />H.P. EA. <br />AIR COND. UNITS-H.P. EA. <br />f 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-R.T.U. M EA. <br />JOS ADDRESS w <br />WALL HEATERS-A.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <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 />FEE <br />INCINERATOR <br />I <br />WATER CLOSET(TOILETI <br />$ <br />I <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK B DISP. <br />SUBTOTAL f <br />DISHWASHER <br />PERMIT f <br />LAUNDRY TRAY <br />TOTAL FEE f <br />CLOTHES WASHER <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUE <br />TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF <br />CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A <br />PERI00 OF 1Z0 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />1 HEREBY CERTIFY THAT 1 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 REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />x <br />WATER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR ETC.1 <br />SUB TOTAL <br />PERMIT <br />f <br />TOTALFEE <br />f <br />SIGNATURE OF CONTRACTOROR AUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REARYAROSETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE M yy RECEIPT NO. <br />M� <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />t vPE OF CONST. <br />OCCUPANCY CROUP <br />NO.OF OW LUNG <br />UNITS <br />BUILDING <br />f) <br />co <br />SIZE OF BLDG. <br />NO.OF STORIES <br />_ <br />MAX.00C. LOAD <br />99 <br />PLUMBING <br />25, W <br />TIR ONE <br />BASEMENT <br />REQUIRED KL []NO <br />❑YES NO <br />MECHANICAL <br />OTHER <br />W <br />SPECIAL CONDITIONS <br />_ - <br />— <br />— <br />- <br />PENELTY <br />SEC. 000(N) <br />I <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS !PACE) THIS IS YOUR PERMIT <br />AwLICAT1@(ACCF.PIITFCP' <br />PLANS fn(fPFD BY� APPRnvlDIO <br />ISSIJM6FNv <br />