Laserfiche WebLink
Ihe Evorpraan <br />CITY OF <br />ever�tt <br />BUILDING DGPARTMENT <br />259•8810 <br />APPLICATI�ON FfJR CONSTRUCT�C,N <br />P�E;MIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />evercll <br />� <br />owxcn maaaooness cnr zir ri�or�E <br />�VUS [cmi?/kNy 3k� �'�"n' /iJe SF . �3co ��ti���f�� `TC,C�fo 1.�y3-�1300 <br />teNerrt n�n��aooness crtr :.ir PIIONE <br />�'�/��'� trI' 3�V �.Yz ACi r_ W1A IZT' <br />AfiCNIIECTORDESIGNEIi MaILA0DRE55 CIIY 21P PHONE <br />�ENERRLCONiRAC�OR IAAiLR00f1E5S GIiY 21P PNONE LICENSE• <br />MECHRNIC�LCONTfl�G10P MAILA�DRE55 CIIY ZIP PIIONE LILENSE• <br />PWMBINGCONTfl\CiOF MRIL�D01iE55 GILY 21P PHONE LIGENSC� <br />O.A550F WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR CI DEI110LITION <br />IEN�Ni IMFROVEMCNT OR INTEiiIOR f1Eht0�EL ONLY —I <br />PRICE OF WOPK <br />LOT BLOCK OF <br />PLUMBING <br />OP FIXTURE <br />KITCHEN SINKf <br />DISHWASHER <br />LAIJNDRY TRAY <br />FLOOR �RAIN <br />BACKFLOW PREV <br />RCOF DRAINS — <br />414K IRFRVI.^.F— <br />ALLOWRBIEIACTUAL <br />FIIiE <br />or <br />TOTAL <br />VES ❑ NO <br />❑v <br />❑ N <br />O VES ❑ NO <br />❑ WOODSTOVE/fRPL INS[RT ❑ OUILOIN� RELOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AND E7(AMIN ED THIS APPLICAT�ON AND <br />KNOW THE SAME TO BE T(iUE AND CORRECT. ALL PFi0VI510N5 OF LAVlS ANU <br />ORDINANGES GOVERNING THIS NPE OF WORK WILL BE COAIPLETED WITH <br />WHETHER SPF^IFIED H EREIN OR NOT. THE GRANTING OFA P[FMIT DOES NOT <br />PRESUME TO GIVE AUTHOfiITY TO VIOLATE Ofl CANCEL THE PF70VISIONS OF <br />ANY OTHER STATE OR LOCAL I.AW fiEGULATING CONSTRUCTION OR THE PER- <br />FORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BYTHE OWNER OF <br />THIS PROPERTYTO PEFFORM THE WORH FOR WhIIG�i APPLICATION IS MADE <br />AND I COMPLY WITH THE STFTE CONTRACTORS LAW 1827 RCW AND <br />298.200 WAC. <br />SIONATUPEOFCONiPAG70FORr1UT110R2EDPGENT �AiE <br />X �.��,r ' ��„ �. .` <br />MECHANICAL <br />NO. TYPE OF EOUIPH <br />AIC—A/HNDLG UNITS— H.P. <br />FORCEO AIR SYSTEMS— B.T.I <br />UNITHEATERS-6T.U. M <br />CWTHES DRYERS <br />VENTILATION FAN <br />WOOD STOVE <br />METAL FIREPLACEB <br />FIREPLACE INSL'(iT <br />HEAT PUMP <br />GAS PIPING <br />p�nn cnecn nun <br />F <br />BUILDING <br />PLUMBING <br />MECHAIJICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />TOTAL <br />Alf <br />L FEE <br />VALUATIQN <br />5 <br />�%� <br />FEE <br />