Laserfiche WebLink
(he Evorpreen <br />CITY OF <br />evereti <br />BUILDING DEPP.RTMEtvT <br />259-8810 <br />APPLIC::�'fION FOR CONS7fi;4�i;TaO�! <br />RERMIT ,.,o �� � <br />^ \V�1 `u^rnV �r1'n` e��emtt <br />v 1 � <br />TO BE COMPLETED IN INK— PLEASE PkINT <br />OWNEN MAILA00lVE55 CIIY IIP PHONE <br />�cr1��� f��clruc�fS 71'< 1�/.0� ��� �� i��,f►c� �vtll� .z�l �rc!-8����d <br />TENGNT Mr11LRODRE 5 CItY Zlp 1 PY.ONE <br />ARCHITECTORDESIGNER MAIIADDRE55 CIfY ZiP PNONE <br />QENEB�LGONTR�CTOf1 M�ILROOf1E53 CIiV ZIP PIIONE �IGENS[• <br />MECHFNILALCONTOACTOq AIAILADOPE55 CITY ZIP PNONE � , LIGENSE� <br />� <br />Gi!� ��,[(� 1�UZ <br />❑ NEW ❑ ADOITION L7 A`_TERAT'OfJ ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FqPL INSERT ❑ <br />CONiRACT PRICE OF WORK <br />LOT BLOCK OF <br />FROJECTADOPE55 _ n � � <br />!� V I , \ <br />PLUMBING <br />:Lt7 <br />KITCHEN SINKB DISP. <br />DISH WASHER <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW FREVENT <br />ROOF DRAINS — RAIP <br />SINK(SERVICE— �AF <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />REOUIPED ❑ YE9 ❑ NO <br />ov <br />❑N <br />� <br />❑ YES ❑ <br />FEE <br />I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED TFi15 APPLICATION ANO <br />KNOW THE SAME TO BE TiiUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANGES GOVERNIM1G THIS TYPE OF WORK WILL BE COMPLE7ED WITH <br />WHETHERSFECIFIED HEREINOR NOT.T!1EGRANTINGOFF. PERMIT �OES NOT <br />PRESUME TO GI VE AUTHORIN TO VIOLATE OR CANCEL THE PROVI3:OIJS OF <br />ANY OTHER STATE Of7 LOCAL LAW REGULATING fpNSTRUCTIO� OR TH E PFR� <br />FORMANCE OF CONSTRUC710N. THAT I AM PUTHORIZED BY7HE OWNEN OF <br />THIS PROPERNTO P[FifORM THE WORK fOR WHICH APPLICA710N IS MADE <br />AND I COMPLV WIThI THE STATE CONiRACTORS LAW 1827 RCW AND <br />296200 WAG <br />SIGNATUREOF ONIRAGTONORAUiHORRF.OAGENT UAtE <br />" ,���-C €� La l(� —�� <br />APP�ICR. TSCIiYDU51NES5UCENSENO.ANOBU51NE55NAME <br />MECHANICAL <br />NO. <br />A/C—A/HNDLG UNITS— H.P. <br />FORCED AIR SYSTEMS— B.T.U. <br />UNITHEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />METP.L FIqEPLACE 8 CHIMNEY <br />PIREPLACE INS�RT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />M EA <br />FEE <br />_ SUBTO7AL � <br />PERMIT 5 <br />TOTAL FEE $ <br />'UNCNECKNUM9Eq FEE HECEIPTNO. <br />FEES VALUATION FEE <br />BUILDING <br />PLUM6ING <br />MECNANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />70TAL <br />