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the Evergreen <br />CITY OF <br />everett <br />IIIY N.9II 1]911M1 <br />I VUFII. w4NINGION <br />41M: <br />GIYI GI[GKNUNIIY BUILDING <br />GEvnnvulNl <br />CONs'rR UC TION <br />PERMIT <br />MECHANICAL <br />F <br />PLUMBING <br />OWNER MAIL AOOHEt"t ZIP PHONL <br />Mlvharl n. Manson 8907. 41th rls-D 93204 313-3070 <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHUNI <br />GENERAL CONTRACTOR MAIL ADDRESS -HONE LICENSE NO. <br />MECHANICAL CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. <br />W <br />m <br />PERMIT <br />CLASS OF WOPK <br />Z <br />®BUILDING SIPLUMBIN13 [MECHANICAL <br />[I NEW El ADDITION ❑ALTERATION ❑RE°AIR <br />F- <br />VALUATION OF WORK <br />$ $1,252.00 ❑DEMOLISH ❑FENCE ❑SIGN ❑SWIMMING P001 <br />d <br />DESCRJEn90 feel rand }. <br />1 1 ... ."A <br />Q1P'�'L1 1c/�NN (/��NN <br />2VV V <br />PROPOSED USE <br />9ai11f1' <br />MECHANICAL <br />TYPE OF FUEL ❑OIL NAT. LPG. 1 _FC. <br />GAS <br />FEGA COPSE RIPTION OF PROPERTY (SHOW BELOW OR ATTACH <br />LOT BLOCK— UF_—._-- - -- <br />it 201 of Lot 6, Ftldland Gar0she No G <br />N0. TYPE OF EQUIPMENT <br />AIR COND. UNITS-H.P. EA. 7 1 <br />REF RIGERAI ION UNITS-H.P. EA. <br />BOILERS-H.P. EA. 1 <br />-- <br />♦ <br />Unplattsd %r_al "Do ad joining S. PAL <br />old C:-Wlpn- <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />FORCED AIR SYSTEMS-B.T.U. M EA._t <br />.1" ant Street J.3.. <br />W O.LL HEATERS-A.T.U. M <br />---- <br />--_I-- <br />UNIT HEATERS--B.T.U. M <br />1 _ <br />PLUMBING <br />EVAPORATIVE COOLERS <br />CLOTHES LAYERS <br />I <br />VENTILATION FAN <br />RANGE HOOD <br />1 <br />AIR HANDLING UNIT— C.F.M. <br />N <br />TYPE OF FIXTURE OR ITEM <br />FIE <br />WATER CLOSET ITOILET) <br />S <br />INCINERATOR __ <br />I <br />BATHTUB <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />SHOWER <br />NA <br />KITCHEN SINK 6 DISP. <br />SUB TOTAL S <br />DISHWASHER <br />PERMIT S <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 />_ _ <br />WATEfl HEATER <br />URINAL <br />CONSTRUCTION OR WORK 18 SUSPENDED JR ABANDONED FOR A <br />PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT 1 "AVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAMc TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WI FH WHETHER SPECIFIED HEREIN <br />_ <br />DRINKING FOUNTAIN <br />FLOUR -SINK OR DRAIN <br />-�_ <br />VACUUM BREAKERS <br />__ROOF <br />DfFAINS-RAINLEADERS <br />_ <br />SINK. ISFRVICE-BAR, ETC.1 <br />OR NOT, THE GRAN'ING OF A PERMIT GOES NOT PRESUME To <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />— <br />ANY OT14ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />-- <br />— <br />OR THE PERFORMANCE OF CONSTRICTION. <br />SUB TOTAL <br />PERMIT <br />f <br />TOTALFEE <br />f <br />61/7/ r7 <br />tt <br />_ <br />SIGNATURE OF CONTRACTOROR AUTH.AGENT DAl - <br />SIDE Yy.E pSETBACK <br />Si�BEET YdVACK <br />REARIORDSETRAC <br />PLAN CHECK NUMBE R <br />PLANCHERCEKC <br />77/330 <br />iFEINE <br />FEE 9 jAQ U <br />US <br />LQTi'! iq. rtVAGANTSIT <br />❑YES []NO <br />FEES <br />_s. <br />VALUATIOR <br />— <br />FEE <br />I YPE OF C NST <br />OCCUPAYY GROUP <br />UNO NI OSF O LLING <br />_ <br />_ <br />I <br />BUILDING <br />5 1 r <br />1 <br />04 <br />612E Oi BI. DG. <br />J <br />NO, OF STYPIES2 <br />MAX. OCC, LOAD <br />PLVMBING <br />Its! 00 <br />I <br />f IIRE NEj <br />BASEMENT - <br />t' <br />FIR SPRINKLE KL F�,S <br />RTOUIRF.D J <br />OYES ❑NO <br />MECHANICAL <br />- <br />OTHER <br />SPECIAL CONDITIONS <br />---------- — ---- — <br />PENELTY <br />SEC. 300 (O <br />I - <br />___.—__ <br />TOTAL <br />I-?� <br />I <br />PERMIT VALIDATION <br />- -- <br />WHEN PROPERLY VALIDATED III THIS SPACFI THIS IS YOUR PERMIT <br />KrYI u:A I I ON 'It It 1 U PY <br />N'(PEI'KIDBY PmPOV1111 <br />Yr <br />•ISaIRNC1 <br />-.e <br />