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The Evergreen <br />CITY OF CONSTRUCTION clverett <br />everett PERMIT <br />HIY Rut lsuln <br />[VERB(. B�SNIMDI JX <br />NTY <br />°`°' °SEE"OP;;;; BUILDING MECHANICAL PLUMBING <br />OWNER MAIL ADDRESS Ji1' PHONE <br />Du= awal 1,10 Pla G• me &N rrw T,-' 0 9132S 35.%•14ml <br />-76 <br />ARCHITECT OR UENGNER MAIL ADDRESS PHONE LICENSE NO. <br />GENERAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />um <br />MECHANICALMAIL ADDRESS PHONE LICENSE NO. <br />ECONTRACTOR <br />PLUMBI'-NrGJCPlAONTRACTOR MAIL ADDRESS PHONE 610ENSE NO. <br />�n1{�`1 <br />cc <br />LEA <br />m <br />PST <br />CLASS OF WORK -- <br />BUILDING LSPLUMBING 11MECHAFIICAL <br />NEW 0AODI710N ❑ALTERATION ❑REPAIR <br />Z <br />~ <br />i <br />VALUATION OF WGRKcc <br />❑UEMOI ISH []FENCE []SIGN ❑SWIMMING POOL <br />LU <br />DESCRIBE WORK <br />aa�r a.T�s aa� Q�cET.rpo <br />1768 <br />PPOPOSED USE <br />MECHANICAL <br />TYPE OF FUEL ❑OIL __0NAT. LPG. ELEC. <br />GAS <br />LEGAL DESCRIPTION OF PROPER I Y (SHOW BELOW OR ATTACH <br />FOUR C PIES( <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />LOT BLOCK—OF�E3tillt'Li <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-TCNNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />I <br />a <br />JOB ADDRESS w. A. <br />r- MI P. <br />_ <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />I <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />1 <br />VENTILATION FAN <br />RANGE HOOD <br />I <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AIR HANDLING UNIT- C.F.M. <br />f' <br />WATER CLOSET (TOILET) <br />S <br />INCINERATOR <br />I <br />BATHTUB <br />+ <br />LAVATORY (WASH SASINI <br />1 <br />SHOWER <br />KITCHEN SINK b DISP. <br />SUBTOTAL. S <br />DIS/IWfBNER <br />PERMIT S <br />LA7NDRY TRAY <br />TOTAL FEE S <br />I <br />CLOTHES WASHER <br />WATER HEATER <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 WORK IS SUSPENDED OR ABANDONED FOR A <br />URINAL <br />PERIOD OF 170 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />DRINKING FOUNTAIN <br />FLOOR -SINK OR DRAIN <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP - <br />VACUUM BREAKERS <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 />E' <br />ROOF DRAINS-RAINLEA DERS <br />SINK (SERVICE -BAR ETC.) <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />- <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SUBTOTAL <br />_ <br />PERMIT <br />S <br />TOTAL FEE III <br />i <br />n <br />SIGNATURE OF EONTRACTOROR AUTH.AGENT DATE <br />SIDE YARD SETBACK <br />STREET SETBACK <br />of <br />REAR YAROSETBAC <br />fw <br />PLAN CHECK NUMBER <br />�M <br />IX�4B`P <br />PLAN CHECK FEE <br />FEE REC ` <br />USE ZONE <br />LOT AREA <br />VACANT SITE11114 <br />AYES []NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST, OCCUPANCY GROUP UNITOS DWELING <br />MM SIZF OF HI DO. NO. OF S OPIES MAX. OCC. LOAD BUILDING S W 31100 <br />FIRE ZON� BASE PLUMBING W <br />i _ IR I RINKL <br />REQUIRED IlI ❑YES pN0 MECHANICAL <br />SPECIAL CONDITIONS: 07HER <br />PENTLTY SEC. 3031.1 1 <br />TOTAL. <br />PERMIT VALIDATION <br />WHEN PROPERLY VAT IOATF.D (IN THIS SPACE) THIS IS YCUR PERMIT <br />AMLIGTION ACCf `EO BY APPROVED FO PdIIANCI BY <br />IPIAWCHFCKtDRY <br />L a as a 14 a <br />a <br />i <br />