Laserfiche WebLink
Iha Everpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />(�M}� /�.. ` <br />APPLICAi ON FOR CONSTRI���ION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />ARCMITEGTOR�ESIGNER MRILAOORESS CITY 21P PHONE <br />C � �a , <br />� <br />everett <br />e <br />� <br />PLUMBINOCONiR�CTON MRILADDRE59 CIIY 21P PNONE �ICENSE� <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVFJFRPLINSERT ❑ BUILOINORELOCATION <br />YTIMP{IOVEMENTORIN ENIORflEM00ELONlY CONTRCTPEHSONANDPH01lENO <br />...,..,,e,,.�„�,.,,.D���G9n� (iA�•l . �iYC %gE2/zH /U�ON INc. <br />LOT BLOCK OF <br />PLUMBINO <br />SINKISEFVICE— <br />SUBTOTAL <br />PERMIT <br />TOTAI FEE <br />OY <br />ON <br />FEE <br />O YES O ND <br />T— <br />�76•'883s <br />I HEREBY CERTIFY THAT I HAVE READ AND �%AMINED THIS Af'PLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF L(�WS AND <br />ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED Wlhi <br />W HETHER SPECIFIE� HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OFi CANCEL TH'c PROVISIONS OF <br />ANY OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTIOIJ. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COlAPLY WITH THE STATE CONTflACTORS LAW 1027 RCW AND <br />296.200 WAC. <br />SIQNRTUNE F ONfRACTOROflAUTNORIZEDAGENT ORTE <br />X . �h'"�I' %-13-8'n7 _ <br />qPP4CRMS.IlY8U51NESSlICENSENO.p� USINESSNAME <br />MECHANICAL <br />TlPE OF EOUIPMENT <br />— AIHNOLC� UNITS— H.P. <br />ICED AIR SYSTEMS— 6T.U. <br />f HEATERS— B.T.U. M <br />GAS PIPIp <br />F�%HAUST <br />SUBTOI <br />PEFMIT <br />TOTAL F <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILD�NG SURCHARGE <br />STATEENERCaYSURCHARGE <br />PUGLIC WORKS <br />TOTAL <br />r <br />