Laserfiche WebLink
b`�PPLICAiION FOR�1�;, <br />'".E".,°'"° CONSTRUCTION <br />an or <br />everett PERMeT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMdLITION ❑ COMBINATIO",J ❑ BUILDING '�MECHANICAL <br />��� .,,�..� <br />� <br />everelt <br />e <br />❑ SIGN <br />�PCHIi(�EG10RpL5�GNEP Mr11lA�pFE55 CIIY Zlv PHpN[ <br />G.�i� FY L(i� � Z[ ��./ � <br />GENEMI GOMB�GIOR IA�IL ADUII[SS CIfY ZIP VI�ONE ICE!!SE � <br />� �7A� � N.ii, <br />MECH�NIG'_CONIPPCTOq MNLADOBE55 CIIY 21P PIIONE IICENSE• <br />�i, n . _ de / ,�...-� o._._ ... ..�_ �•�.. _. _ /Ynr.m rlio n.. �i-dl'M[A-�D� <br />(( Cl <br />�tu sorwone - <br />EW ❑ AD�ITION ❑ ALTERATION ❑ REFAtR ❑ D[MOLIIION ❑ WOODSTOVE/PHPL.INSERT ❑ BUILDING RELOC'.110N <br />WlU�iION OF WORN �CO51 OI M4LEBULS PWS lPo0f11 <br />�� bo�, <br />�ESCAiBE WOAK <br />IISE OF <br />L01_ BLOCIt__ <br />FLUMBING <br />NO. T�PE OF Fll <br />WATEP CLOSET �TOIL'. <br />BATHTUO <br />LAVATORV�WASH BA: <br />SHOWER <br />KITCFIEN SINK 8 OISP. <br />OISMWASHER <br />LAUNDRYTPAY <br />LLOTHES WASHER <br />1RONTSETBALN <br />iVPE OF CONST. <br />OFBL00 <br />- RqINLEADERS <br />- BAR. ETC.) <br />� <br />I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRFCT. ALL <br />PROVISIONS OF LP WSAND ORDINANCES GOVERtdINGTIIISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIF?D FiERE• <br />IN OR NOT. THE GRANTING O� A PERMIT DOES NOT PRESUME TC� <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV�SIONS O�' <br />ANY OTHER STATE OR LOCAL LAW pEGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. , <br />SIGNATUREOFCONTRACTORORAUTIIORIZEOAGENT �qTF: <br />X �,� <br />APPLICANiS GiY Bi <br />MECHANICAL <br />FEE NO. <br />� A/C - AMD <br />Yi13�.I3�•DlldSl�iYl <br />BOILERS - B.T.U.M.P. <br />GAS FIRED A.C. UNITS - B.T.U. <br />FORLED AIH SYSTEMS - B.T.U. M EA. <br />WALL HEATEfiS - ii.T.U. M <br />UNIT HEA7EF5 - B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHESDflYEFS <br />VENTILATION FAN <br />� RANGENOOD <br />WA7ER HEAT[R <br />wOODS70VE ` <br />�- METAL FIREPLAC[ 8 CNIMNEV <br />�- FIflEP1ACE INSERT <br />�- HEATPUTAP p <br />(y GAS PIFING _ <br />/ E%HAUST FAN � IT7:Ur� <br />TOTALFEE J I <br />RERRSEiBACN SIOESET6ACK <br />LOtAREA. VACPNTE�IE <br />OYES ONO <br />DC:UPRNGYGflOUP NO.OFOWFILINGUNlTS <br />NO OF SiOR1E5 MA% pp�. LOAO <br />7ED ❑ VES ❑ NO <br />PLP.NS CMECNED BY FPPR FOR ISSURNLE BY <br />SUBTOTAL <br />VEflMIT <br />PLAN CHECK NUMBER � FEE <br />6WLD�WG <br />PLUMBING <br />� <br />�ee <br />RECEIPT NO. <br />FEE <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />S7ATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNEflS ARE RESPONSIBLE FOR DETERMINING ALl <br />PROPERiY LINE LOCATIONS AND RELATED EASEMENTS. <br />