Laserfiche WebLink
'`'��'PPLICATION FO►.� everetl <br />:. <br />�- INEwrprs�rett ��NP RM TTION � - � <br />��ry Q� <br />eve <br />BUILDING DEPAR7MENT TO BE COMPLETED IN INK- PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION O(BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />CWNER N�ILADDRE55 CIIY ' ZiV FIIOrvE <br />, <br />A�r_ =wv� -rr�n� T � �►cr . �, �cc �q-g- � z3q- <br />_""____._..__ aeu ennaF55 CITY 21P PHONE <br />0 <br />GEN[ML <br />�� <br />I�tC1mA� <br />vwuau+ <br />MRIL <br />MAIL <br />L <br />, zlhzt3 <br />�PONE UCENSE• <br />I�ix= WA 9BZ72- <br />UCENSE • <br />=I163c� <br />GL�$$O� WOPK <br />❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ DEMOLITION ❑ WOODS70VE/FRPL.IN:iER7 ❑ DUILDING �[LOCNION <br />haw�rloN oF wonH �co5r oF MA�[n�Rts rlu5 LAeaR1 <br />WOHI( <br />YN[IJtI� � A V V ML�: <br />� (�UC� <br />PLUMBING <br />NO. � TYPE OF FI%TURE OR <br />� WATER CLOSET (TOILET� <br />BATHTUB <br />' LAVATORV�WASH BASIN� <br />�i �..�...�� <br />A <br />KITCHEN SINK 8 OISP. <br />DISHWASHER <br />URINAI <br />�RINHING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTEAS <br />FOOF ORAINS — F7A�NLE/ <br />SINN �SEPVICE — BAR. El <br />«ONT SEtOAGn <br />/ <br />P- Z <br />�`IPE�FsONSt <br />� _� <br />AV4�uCAlIONPLC Bv <br />�V v <br />on <br />SU9TOTAL S� <br />PERMIT f <br />TOTALFEE _ <br />RSEiBnCK $IOESE104C4 <br />i .i <br />AFER VGfG11S CISF <br />is- � �v,4 <br />NO OF STOf1iES MA%.00G IOAp <br />/ Nd <br />ov <br />I HEREBI' CERTIFV THAT I HAVE READ AND EXAMINED ThIIS AP� <br />PLICATION AND KNOW THE SAMETO BE TRUE ANDCOFRECT. HLL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED I1ERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR T:1E PERFORMANCE OF CONSTRUCTION. . �} <br />$IGNA7URE OF CONTnnCTO On iNOPIZEU AGENT DniE Ir/ZS („� J <br />X <br />�PPLICANI'SCIfY0U51tIE5 lNiEHO <br />MECHANICAL <br />NO. TYPE OF EOUIPMEI�S <br />A/C — A/NNDLG UNITS — H.P. <br />flEFPIGEPATION UNITS — H.P. EA. <br />BOILERS — B.T.0 /H.P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FOHCEDAIRSVSTEMS—B.T.U. MEA. <br />WALLNEATERS—B.T.U. M <br />UNITHEFTEPS—B.T.U. M <br />EVAPOPAT�VE COOLERS <br />CLOTHES�RYERS <br />VENTILATION FAN <br />RANGEHOOO <br />WATERHEATER �. <br />WOODSTOVE <br />MEfAL FIFEFLACE & CHIMNEV <br />FIREPLTCE INSEPi <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />P�AN CHEGK NUMBER <br />SUBTOTAI S <br />PEflMIT S <br />TOTALFEE f <br />FEE PECEIPT NO. <br />� InU �- �� <br />BUILDING g <br />PLUMB�NCa <br />MECNANICAL <br />OTHER <br />STATE �UILDING SUPCHARGE <br />STATE ENERGY SUHI:HARGE <br />Pl1BLICN'UF.I!0 <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AlL <br />PROPERTY LINE LOCATIONSAND RELATED EASEMENTS. <br />