Laserfiche WebLink
� th� Everyreen <br />CITY OF <br />� everett <br />BUILDIN(i DEPARTMENT <br />259•8810 <br />,.:;;., <br />APPLIC�+►`rION FOR CONSTRIi�:T10N <br />PERMIT � <br />TO BE C067PLETED IN INK— PLEASE PRINT <br />ANCHREGTONDEBIONEN M�II.�OORE95 GITY ZIP VHONE <br />everelt <br />� <br />OENEMLCONTR�GTOR MML�DDNE59 CITY 21P FNONE UGENSE� <br />PLUM&NOfANTR1ICTOP MAILAO�PESS CITY 21� PNONE LIGENSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ UEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDIN6RELOCpT10N <br />OpNTMCT PPICE OF WOqK <br />DEBGPoBE WORN IW U 80UME i00TA0E INVU' <br />Snbl� �o,l ��r Ta..,E <br />PIqPOBED SEO�BUILOIN <br />G�� bu�Id�AA a�J'FR <br />LOT BLOCK OF <br />� ��,�� / <br />; � / 27 / ��oNf iHn P� _Y I.�n <br />xurnNa <br />KRCHEN $INK 8 013P. <br />OISHWA9HER <br />BACKFLOW PRE1 <br />ROOF DRAINS — <br />SUBTOTAL <br />PERMIT <br />❑ YES ❑ NO <br />I HEREBY CERTIFYTHAT I HAVE READ AND EXAMINED THIS APPLICAiION AND <br />KNOW THE 3AME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLETED WITH <br />W HETHER SPECIFI ED H EREI N OR NOT. THE GMNTINO OFA PERMIT DOES NpT <br />PRESUME TO (iIVE AUTHORIiY TO VIOUTE OR GINCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION ORTHE PEfF <br />FORMANCE OF CONSTRUCTION. TNAT I AM AUTHORI2E0 BY THE OWNER OF <br />TH19 PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CqNTRACTOR3 LAW 1827 RCW AND <br />296200 WAC. <br />SION�NNE FCONTR�CiOROR�UTH ED D�TE � � � <br />x `r7. " 3' 9 <br />�PPUCIWTS CITY BU91NP 5 UCEN9E NO. FYO BUSINE59 N�ME <br />MECHANICAL <br />NO. TYPE OF EOUII <br />IVC — A/HNDLO UNITS — H. <br />FORCED AIR SYSTEMS— fl <br />_ UNITHEATERS—&T.U. � <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMN <br />FIPEPLACEINS RT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />O YES ❑ NO <br />' NO.OFDWELlINOUNIT3 BUILDING <br />PLUMBING <br />BSMT. OCGLO�D <br />o Y MECHANICAL <br />ON <br />HeiaHr��:niunon OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />� PUBLIC WORKS <br />TOTAL <br />TOTAL FEE <br />a <br />a <br />