Laserfiche WebLink
APPLICI.`�ION FOR CONSTRI.�;T10N <br /> PERMIT <br /> fh�Erorpnsn <br /> CITY OF cvcretl <br /> everett e <br /> BUILbING DEPAFTMENT <br /> ?S9•P810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> �YI�QS. <br /> OWHEH � M�II.nDPN[SS GIIY ZII PNVNE <br /> /YIR S, fi�%'=Y0/�,E- /3�;�G�t�I .�vr�R��7T" 9ea�� � <br /> TENNIT MiJUD�HESS CrtV IIP PNp E <br /> MCHREGi011DCSIbNER MAllllOpN[59 GiV IIP PNpNE <br /> OENER�LCOMiP�CTOR Me1L�DDRES4 L11Y 21P MIONE LILCNSE• <br /> �//�'//�/lr C'r�iu�'�9L C�tJ71C!`�c�Z7/LS � 9�v-�l aZa'97zsv Vi/l�//DutJ <br /> 1MNIGLCONTMGiOP MA�I�D�AE% G1Y ZIP PMOH[ �ICENSE• <br /> /LUMaN�CONiR�GTOR MML�DORESS CiTY ZiP PMONE 110EN4E• <br /> CWlOFPWHIc � — p� <br /> Q NEW ❑ ADDITION ❑ �LTERATION p PEPAIfl ❑ DlMOLITION ❑ WOODSTOVFJFPP�INSERi ❑ BUILDIN6qELOCATION <br /> IEMN/T IMPHOVEMEHip11HTEHiOR REMODEL ONLY CANi�GI PERSON�NO PHONE NO <br /> , �,,,�,��oF�K �8�99�- -- <br /> p[lCRIlE Y/pp1l�NnD 80UM^E F_�—T��GE INV01VE0 <br /> / `�/_ --" <br /> wqvo�[o ua¢a euadNa I HEREBY CERTIFY THRT I lIAVE READ AND ExRMINED THIS APPLICATION ANO <br /> KNOW'HE S�ME TO BE TRUE AND CORWECT.ALl PROV�SION9 OF LNVS AND <br /> �a.o CRIPf10NOFP110PERTYIBNpWHBEIONOR�R�CNfOUNCOPIES� ORDINANCESGOVERNINGTHISNPFUFWORKWIILCECOMPLETEDWITM <br /> WHEiHER SPECIFIED HEREIN OR N(11.THE GRANiIN00FA PERMIT DOE$NOT <br /> PRESUME TO GIVE AUTHORI7V TO VIOLATE OR CRNCEI.THE PROYISIONS OF <br /> wr elocK ov ANVOTHERS7ATEORLOCALLAWREGUUTINOCONSTRUCTIONORTMEPEH- <br /> FORMANCE OF CONSTRUCTION.TNAT 1 AM AUTHORIZED BV THE OWNER OF <br /> THIS PROPERTV TO PERFORM THE WORK iOR WMICH APPLICAiION IS MADE <br /> AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 qCW AND <br /> _ z�z�WAG y�zy/Pt <br /> &ONQUREpfCONiFACt0�00AU1NORVF.OWENT �ATE <br /> � 3� Y coc,¢y .��- X ���--,- <br /> I �'���pEsy APPLIC�NTSCIIYBUSME&9uciNSENO.�NOBU&NESSNIIME <br /> i <br /> � RUM�INO MECHANICIIL � <br /> f NO. TYPE OF FIXTUIIE 0111TEM FEE NO. tl?E OF EOUIPAr�ENT FEE <br /> WATER CL09ET(TOILEn NC–A/HNDLG UNITS–H.P. <br /> ' BATHNB FORCED AIR SYSTEMS–ET.U. M EA <br /> LAVATORVryVA9H BAS�M UNIT HEATERS–B.T.U. M I, <br /> BMOYVER CLOTHES DRVERS <br /> KITCHEN 31NK6 DISP. VENTILATION FAN <br /> C19HWASHEN RANGEHOOD <br /> UUNDRYTMV � WATERHEATER <br /> CLOTHE9 WASHER WOOD S10VE <br /> UNINAL METAL FIt7EPLACE 8 CHIMNEY <br /> � DRINKINO FOUNTAIN FIREPLACE INS�RT <br /> FLOOR DRMIN HEAT PUMP <br /> BACKFLOW PNEVENTEHS GAS PIPINO <br /> ROOF DRAIN9–RAINLEADERS EXHAUST FAN <br /> SINN�SERVICE–BAR ETC.) <br /> SUBTOTAL S SU810TAL S <br /> `_ PERMIT S PERM'T E <br /> v TOTAL FEE S TOTAL FE[ S <br /> iRIXIiSET9ACk RFJ�RBElB4LK S��ESITB�GN PUNCHECKNUMBEN FEE RECEIVfNO. <br /> USE20NE LOT�RE/. VRGANf511E FEES VALUATItlN FEE <br /> C]YES ❑NO <br /> BUILDING <br /> iYVEOFCANSC OCGUG�NCYORWP NO.OFOWELLINpUNIi5 <br /> u����E��� PLUMBING <br /> &2EOFBlOQ NO.OFS�OFIEB BSMt, pGCLO�D <br /> o v MECHANICAL <br /> ON — <br /> NE1011TLIMIi�f10N OTNGR <br /> FlRE9PRINNlEPSREIXlIRED OYE9 ❑NO STATEBUIL�INGSURCHARGE <br /> STATE ENERGV SURCHARGE <br /> MPLIC�TION�CC B� PlRN9�PP0.OY <br /> PUBLIC WORKS <br /> TOTAL <br />