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the Evergreen <br />cl rY Or <br />everett <br />Olr alG nlvwe <br />IVTFH, W,SRMGIOK <br />NMI <br />01 PI of LOYKI1 it <br />GIV(I BFMINI <br />'/W�YN,PE�RIN RW <br />CONSTRUCTION <br />PERMIT <br />BUILDING MECHANICAL PLUMBING <br />MA11 ADD�RRUSSS� II• <br />r. r'. 30 iFYi rr,,,OpAm <br />PHU'VI: <br />---- •—•.... ..cma�rvcH <br />—MA IL -Won RESS <br />PHONE <br />LIC' NSEE h <br />GENERALCONTRACT Oq <br />cAM1a'65 <br />MnIL AOD gE3S <br />_ <br />-- - PHONE <br />' <br />L ICIi NSE N <br />ME C IIAN I C ALCONTR AC T O R <br />MAIL AI]OgESD <br />- PHONE <br />Aye <br />LICENSE N <br />PLUMBI G CONTRACTOR -- <br />Sala <br />MAIL ADDRESS <br />_ <br />PHONE <br />LICENSE Ni <br />PERMIT - -'---- <br />CLASSOVWORK <br />-- ---- <br />[BUILDING IXPLUMBING,LIMECHANICAL <br />VALUATION OF WOgK--- - '- "--------- <br />NEW <br />------ <br />❑AODITION ❑ALTERATION ❑gEPAIR <br />§ ismasallo <br />DESCRIBE WORK ------ <br />❑DEMOLISH <br />____- <br />❑FENCE ❑SIGN <br />- <br />❑SWIMMING POOL <br />R70_:1"M7 <br />Ffi'7tlr <br />elverett <br />�73-7G <br />�"l`"I <br />PROPOSED USE <br />575 <br />MECHANICAL <br />I O U R LDEI E SIC:RIPT ION OF PROPERTY (SHOW BELOW OR AT TACH <br />TYPE Of FUEL. QOIL OAS❑EPG. ELEC.-- <br />, <br />O <br />IT BLocK <br />7YPEOFEQUIPMENT <br />_ <br />AIR COND. UNITS-H--H.P. EA. ---- FEE_ <br />ERATIONLINITS H.P. EA. ---------- t- <br />GAS FIRED A C. UNIT5- rONNAGE EA. I - <br />108 ADORES$ - - "-' <br />1.� se <br />------ _ <br />�y <br />_ FORCED A —MS B.T.U. M EA. <br />WALL <br />•rt, <br />_ HEATERS-B.T.U. M <br />PLUMBING <br />--- __ <br />UNIT HEATERS--B, T.U. M -L <br />EVAPORATIVE COOLERS ----'T' <br />- <br />- <br />_ CLOTHES DRYERS - <br />VENTILATION FAN I - <br />TYPE OF FIXTURE OR ITEM <br />RHOOD <br />WATER CLOSET ITOI LET) <br />--�- FEE <br />�-1 <br />AIRIR HANDLING LING UNIT- - <br />C F.M. <br />BATHTUBIINCINE <br />t- <br />RgTOR _ - <br />LAVATORY (WASH BASIN) <br />I_ <br />SHOWER <br />KITCHEN SINK d <br />DISHWASHER------"'- <br />---------- <br />-- I <br />_-_- SUBTOTAL § <br />LAUNDRY TRAY <br />-'-- -----I <br />------- PERMIT § - <br />CLOTH ESWASHER----'-- <br />------I <br />_ WATER HEATEfl _ --" <br />----i-, <br />TOTAL FEE S <br />Pf.RM1T BECOMES NUIJ. <br />URINAL ---- <br />-----I <br />AND VOID IF 'WORK <br />'I AUTHORIZED IS NOT COMMENCED WIl HIN 120 RD <br />DRINKING FOUNTAIN <br />F IOOR-SINK OR DRAIN <br />-- I'•T <br />---� - <br />AOVS ORUC <br />RUCT ION OR WORK IS SUSPE NOED OR ABA NOONED FOR IF <br />A <br />n100 OF IZO DAYS AT AN V TIME AFTER WORK IS COMMENCEO. <br />__-- <br />VACUUM BREAKERS _ <br />ROOfDRAINS-RAINL EADE_RS_ <br />-�---- <br />—'-'-�- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PI (CATION AND KNOW THE SAME TO RE TRUE AND <br />PROVISIONS <br />SINK ISERVICE-BAR. ETC.) <br />---'-'-'}-- <br />CORRECT, ALL <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WIZ. I. BE COMPLIED WITH WIIE7HER 9PE SPECIFIED <br />OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME IN <br />HEREIN <br />GIVE TO VIOL AIE <br />TOTAL <br />OTHER DR CANCEL THE PROVISIONS OF <br />STATE <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE <br />----SUB <br />--- <br />OF CO rvST RUCTION. <br />PERMIT <br />f -'- <br />.___- TOTAL FEE <br />XCNA7URE <br />SIDE YARD SETBACK SIREEISETBACK <br />OF CANTRACTOR OR AVTH.AGENT CATER' - <br />RLARYAROS E (RAC <br />PLAN CHf CK NUh111ER <br />PLAN CHF CK FEE <br />USE ZONE -- LOT AREA <br />VACANT SIT E <br />RECEIPT NO <br />FEE Tie" <br />DYES ❑NO <br />lw <br />TVP OF CON91. OCCUPANCY GROUP <br />NO, OF OWE LONG <br />�— FEES VALUATION FEE <br />UNITS <br />SIZE HI.OG. NO. Of STORIES <br />MAX, OCC. LOAD <br />- --- -- <br />BUILDING <br />35bWbryE y� <br />S JJYY M/ <br />FIR ZONE 13 AS NT--- <br />IR S AINKLER§ <br />PLUMBING » <br />REOUIRED <br />f/ <br />❑YES ONO <br />_ <br />MECHANICAL - <br />SPECIAL CONDITIONS <br />I <br />-- - - <br />OTHER <br />I <br />PENELIY SEC. 3031a1 <br />TOTAL <br />176 I0D <br />PERMIT VALIDATION <br />-- <br />WHENPROPER(. Y VALIDATED 1 IN 71115 SPACE) T131S IS YOUR PE RMIT <br />it <br />W <br />H <br />