Laserfiche WebLink
E. <br />r <br />F: <br />�n� <br />O � x <br />9HVHi <br />4 <br />H�H <br />FC C] <br />H �1 <br />K�.1 M '��J <br />CA H <br />C�7 O � <br />H C7 <br />OH <br />��g <br />�V nC <br />� H C+] <br />z <br />I--� y <br />8y <br />H <br />O5CyN <br />W r�r1 <br />H f/� <br />HOcn <br />� �, <br />APPLICATION FOi� CONSTRUC'TION PERMIT <br />lAeEvergreen C'VC'fB[t . <br />CITV Of- � � <br />everett <br />BUILDING DEPARTMENT � <br />259-8810 ��� BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATIO�' ❑ BUILDING 1 1 MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER M�ILADDRE55 CITY ZIP PMONE <br />u�1N� i2t �r�in� lb'CJf7 Qe�2!;ta nR �'�dv f%i�r{on� 1�CXdt 77057 i7/3� ,�,(6-�6'/G <br />1 NANL MAIL�DORE55 T CITY 21P PNONE '.� <br />I <br />�RCNIIECTOROESIGNER MAILRDDRESS QiY ZIP PHONE <br />� <br />MAI� ADOPE55 <br />MEGH�NICALCOMRAGIOH bmanuuness <br />{�Ili GIY 1'IIVIVC LIVCIY�C• <br />r,r �„��r �,�r�„r. <br />� .�,_�_. ,,, ,..... - <br />L 1 NEW [J ADDITION U ALTERATION L I REPAIR I 1 DEMOLITION I_I WOODSTOVE/FRPL INSERT U BUILDING RELOCATION <br />TEN4Ni IMPROVEMEIIT OR INiER10R PE6�ODE�ONLY CO4tACi PEPSON ANO PIIONE NO. <br />CONIflACTPRICEOF WOBN: <br />DESC(iIBE WORK ANO SOUAPE FOOTAG[ INVOLVED <br />LEG�I �ESCNPIION OF PBOPERTV (SHOWN OEL01 <br />�or o�ocK oF <br />PRQIECTAD�PESS <br />TYPE OF <br />iINK 8 <br />1ER <br />TRAY <br />�/ <br />I HEIiEBY CERTIFY THAT I HAVE READ AND EXAMINED TH�S <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PEflFORM THE WOFK FOR WHICIi <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGNAtUREOFCONiMGTO110flRU1HORREDRGENT DRtE <br />\ /��_��i/i�fl � <br />AP ISCITYOUSM[SSLIGE N � USINESSN�ME <br />MECHANICAL <br />�O. TYPE OF EOUIPMENT FEE <br />�C—NHNDLG UNITS—H.P. � <br />FORCED AIR SVSTEMS—B.T.U. M E.A. . <br />CLOTHESDRYERS <br />VENTILATION FAN <br />II�F9�:11 <br />SUBTOTAL $ i <br />PERMIT $ � <br />TOTALfEE $ <br />PPONTSETBRGN RE�RSEip�CN SIOESEI�ACK PLANCMEGHNUAIpER FEE <br />USEZONE LOTARE4 VAC�Ni511E FEES ' <br />❑ YES I I NO BUILDiNG <br />IYPEOiLON$I.AIWWABIE IYPEOFCONSI.ALIUAI atu�nxn xnaow[LLixcuxn5 � <br />LPWP <br />rwn+oiNc <br />SIZEOFBLDCi. NOAFSTOf11E5 OnSEMEN� MECIIANICAL <br />CI YES LI NO <br />OCGUPANCYLOAD FIRESPfINNlEP511E9D H[IGNT��MIiALION OTHER <br />❑ YES CI NO STATEBWLDINGSURCHARGE <br />REASONFORSPRINKLERS � <br />STATE ENERGV SU(iCHAqGE <br />pPPLICATIONAGGOY PLANSAPPROVEDOY CITYOFEVEflE1T PUOLICWORKS <br />LOCALSALES <br />TAX COOEIS 3105 TOT�� <br />YG}y:l� <br />ECEIPt N0. I <br />FEE <br />0 <br />