Laserfiche WebLink
� <br /> 1�"��;:, ,`:'� ' < <br /> APPLICa''i'ION FOR CONSTRU':.TION � <br /> PERMIT � <br /> eCvC�preM CVCrCtI � '�. <br /> iV Of 0 I <br /> �verett � <br /> UIIDING DEPARTMENT � <br /> ,g.gg�p TO BE COMPLETED IN INK— PLEASE PRINT � <br /> � YNCR ,aUII=DDF65 GIIY ZIP PIIONE . <br /> � L=1,�+���—L=���"�1.�3_��u�6�—�v_�_�L�cLCT-1�-�d�'�- ; <br /> � ���H�f M41L�ODRE55 GItY ZIP PNONE <br /> O � 1/� —� ^ o ��-2iG� : , <br /> Q� l�� WY ZIP %IONE • I <br /> � ��crurccronoes�a� MAILAOORE55 — <br /> � � '�' CIIY IiP 1a�ONE LiCENSE• � I <br /> '�llEMLCON�PRL1011���A IAFILAOONE55 ' � <br /> ��� ' MAI��pppC55 CI�Y ZIP VMONE 4GENSE� � fl <br /> a '[�IIANICALCONIIUCIOfi '.I <br /> �_� IUMO�NGCONtRAGIOR MAIL�Dpf1E55 CIIY , 2iP PHOHE UCCNSE• <br /> �� ��tuw_t�—���u��5���.1_`�—.�a��s.,/ /p �1%o—fi�'.laoZ /-(��d�R'.,0 I <br /> �y�f��J �nssoi'wonK I <br /> H�q ��yY ADDITION �ION ❑ REPAIR ❑ DEM170LITION ❑ WOOOSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> �" �� �rr�uain�rn EMENIOPINIERIO��^^ODCLON�Y GONIACIPERSOHAMOPIIONENO <br /> �y� Y/ ,,ll'� � — � <br /> ONIMGf APICEOf WORK � <br /> CSCIIIB[WORNl.ND SOUARE�W�/AE�NVOLV[0 � <br /> u — ! <br /> � ��oros � eov u• owa IHEREBYCERTiFYTMA7IHAVEREADANDE%I.MINEDTHISAPPUCA7IONANO �� <br /> � _ J 2 y��i7 /n � _ KNOWTHESAMETOOETqUEANDCORRECT.ALLPROVISION50FLAWSAND 'I <br /> � LSSL(—_/��� ORDINANCFS COVERNING THIS TVPE OF WORK WILI BF.COMPLETED W�TH <br /> t,nLOCSCftiPlONOffnOPERrv�5110NN8ELOw.U�rT���� ��� i[s� WHETHERSPECIFIEDHERHINORNOT.THEGRANTINGOFAPEfiMITD0E5N0T <br /> y U � PPGSUMETOGIVEAU7HORITY70VIOLATEORCANCEITHEPROVISION50F �I <br /> Q(q �� eiocK__ or ANY�iHER5Tn1EORLOCALI.AWREGULA7INGCONSTRUCTIONORiHEPER� <br /> FORMANCEOFCONSiRUCTION.TIIATIAMAUTHORIZEDBVTHEOWNEROF . <br /> ~ iHISFROPERTYTOPERFORIdTHEWORKFORWMICHAPPLICATIONISMADE � <br /> AND I COMPLY WITH THE SfA7E CONTRACTORS LAW 1827 RCW AND i <br /> 296.200 WAC. p(�� <br /> sw AmrForcor+tnac�onneeUnwn¢eomcNr o�iE ��• �U • J/� ,i <br /> npJ[�IApDRE55 �— FUCANi5Q1VAU51NC. IIGCNSENO.�NOBU51NE55N�ME I <br /> .� � � � I <br /> PLUMBING MECHANICAL <br /> I��� — I <br /> Np, TYPE OF FI%NRE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE .i <br /> WATERCLOSETITO�LEq F �_ NC—WHNDLGUNITS—N.P. �•I <br /> � f � T� BAiHiUO _ _ FORCEO AIR SYSTEMS—B.T.U. M EA ___ <br /> 1 / LAVA70RYIWASHBASINI UNITHEATERS—Bi.U. M — <br /> �� y CLOTHESOFYERS <br /> SHOWEq <br /> � � KIiCHEN SINKB DISP. � VENTILATION FAN _ '� <br /> '� �� �ISHWASHER _ RANGE HOOD _ <br /> i LAUNDRYiRAY WATER HEATER � <br /> CLOTNESWASHER _ WOO�STOVE <br /> I �� � URINAL _ � _ _ METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNiAIN FIREPLACE INSEfU <br /> .. FLOOR DR�IN HEAT PUMP � <br /> � BACKFLOWFFEVEIJTERS GASPIPING ' <br /> � a� ROOF DRAINS—RFINLEADERS E%HAUST FAN <br /> SINK�SERVICE—BAR,ETC1 _� — <br /> I _s1 = — <br /> I __-- <br /> _ SUBTOTAL 5 c_ • SUBTOTAL 5 _ <br /> _' _ PEPMIT S _� _ _ PERMIT E _ _ <br /> �' T07AL FEE E <br /> TOTAL FEE 5 <br /> - fRON15[lOALN REARSEiB�GN SIpE5C10AtN PIaNCNEC6NUMBEP FEE PECEIPTNO. <br /> 115EZONE torenu VAGANISIIL FEES VALUATION FEE <br /> ❑YES ❑NO <br /> �UILDING <br /> IVfEO�GONST. OGGUPANCYGBOUP AOOFDW[LLIIIOUNIIS <br /> nuowno��sarw� PLUMBING <br /> sizeoro�on Noo�sron¢5 osMc occ�oeo MECHANICAL <br /> ❑Y <br /> ❑N _ _ _ <br /> neicrrtu�.�i�nnou OTHER <br /> nnesrninrciensneownEo ❑r¢s o e+o STATE BUILDING SURCHARGE <br /> STAiEENERGYSURCHARGE � <br /> nrvuc�uor+eccor PUNS�PPfl.OY PUBLIC\YORKS <br /> TU7AL <br /> � . <br /> w_ _ _. <br />