Laserfiche WebLink
pppL,IG`�lTi ION FOR CONSTR�CTION <br />PERMIT <br />fhe Evory�een everett <br />CITY O` � <br />ev��reti <br />BUILDIIJG DEPARTMENT <br />P59.gg�p TO BE CORIIPLETED IN INK— PLEASE PRINT <br />OWNER M�ILApORES9 GIiY ZIP PHONE , <br />�. / v i/ / ._.... .y. i. G..___� 9P�1n3 .353-50J/ <br />MGNITECTOFOEBI�NER MAIL�ODRESS CITY Z�P ' PHOHE <br />OENER�LCONTIIACION IA�ILAO�HESS CITY ZIP PNONE LICENSE• <br />S0.1hC. MAILAOOPESS GRY ZIP PHONE 4CENSE• <br />MECH�NICA�CONTNAGTOfl � <br />PLUM&NOCONTIiAGTOR MAll�0�NE5S CITY IIP PMONE LIGENSE• <br />GtA`FY V � �nn �..,( <br />❑ NEW ❑ ADOITION Jd� AI.TERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILOINGRELOCATION <br />TENNITIMPROVEM[NTORINTENIORREMODELONLY CANTACTPERSONANDPNONENO. ���KasJ <br />!� / / //. /� � ? L'9 . G <br />CONTR�CT PPICE OF WORK <br />DEBGRIBE WO/N,K �N� SOU�RE FOOTAQE INVOLVEI <br />/h t:.r�/ �'h.� sf�w.ct.,art — <br />lOi� BLOCK OF <br />P4UMBINO <br />YiIL <br />BACKFLOW PRE� <br />RGOF DRAINS — <br />� � 6ae%roon. <br />� <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL FRO:'ISIONS OF LAWS AND <br />OROINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLE7ED WITH <br />W HETH EF SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUMc TO GIVE AUTHORIN TO VIOLATE OF CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION UR THE PEP.• <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHOR2Ef: ifY THE OW NER OF <br />THISPROPERNTUf'ERFORMTHEWORKFQRWHICHAPPLICATIONISMADE , <br />AND I COMPLY WITH THE STATE CONTRACTORS L�W 1027 RCW AND <br />206200 WAC. <br />SIGNFTUREOFGONTPACIORORAUTHOPREDAGENT OATE <br />X� /� !� ���. <br />APPLIGRNTS TY JSINESSLICENSENO. BUS�NESSNRME <br />MECHANICAL <br />Op ITEM FEE NO. TYPE OF EOUIPI <br />A/C — A/HNDLG UNI7S — H.P <br />FORCED AIR SYSTEMS— &T� <br />UNITHEATERS—&T.U. M <br />CLOTHES DRYEFiS <br />SUBTOTAL 5 <br />PERMIT S <br />TOTAI FEE 5 <br />T&1f:K PEAfl5E18RCK SI�ESETB�CK <br />2O IOTMEA �O �ACANTSIT€ � <br />' 0 YE9 � NO <br />;OHST. OGGUVANCYaROIIP NO.OFDWELI.INa <br />«,����� v, N R.3 1 <br />�p({ NO.OFBTOflIE3 &SMT. OCGIO�D <br />I ioN �/a <br />FIRESPPINKLEF9 <br />O YE9 a No <br />WOOD S?OVE <br />METAL FIREPI <br />FIREPLAGEIN <br />FAN <br />BUILDIN6 <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />STATE BUILDIN65UPCHAA�� <br />STATE ENERC,V SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />T�7I11 <br />fy�q <br />M EA <br />FEE <br />