Laserfiche WebLink
�everett <br />BUILDINO DEPARTMENT <br />269�8810 <br />APPLIC�ON FOR CONSTRIi�GT10N <br />PERMIT <br />TO BE COMPLETED IN 1NK — PLEASE PRINT <br />everett <br />e <br />�R�I�II[f77pppE6qNER MI�IL�DD11E59 GTY ZIP PHONE <br />���C���OR WIL�DOPE34 CITY 21P VHONE LICENSE• <br />C�W n P r �„� ZIP PNONE IICENSE• <br />�����rop 1MIL�ODRE9S <br />RUMMN4WMTMCTOp M/uL11DORE9S GTY 21P PHONE LIGENSE• <br />❑ NEW 1� ADDITION ❑ ALTEMTION ❑ <br />�."�•.:C9 <br />�� lLOat� <br />�.�ui - <br />KAIM�ING <br />� <br />� <br />I-1 oEMOLI710N ❑ M/OODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />p�qBfly�K &DESETBI�CK � <br />� Zo ia' s <br />�mu�u � v�c�r+rair <br />, w__ O YES NO <br />(jCliCJ <br />OGCUMNCYOROUPm � �.��«���N�� <br />N0.0FB70PIE8 BBMT. OCGLWD <br />� � <br />MEIONTLIMIdTqN <br />o vee o <br />RANBMPRlY <br />aa �'`� <br />�' i <br />\VE f!EAD AND <br />IEANDCORRF <br />THIS TYPE OF <br />FORMANCE OF CANSTRUCTION. 7HAT 1 AM AUTNOR¢Eo er me owner �r <br />THIS PROPERTYTO PERFORM 7HE WORK FOR WHICH APPLICATION 19 MI1DE <br />ANO 1 COMPLY WITH THE STATE CONTRACTOfi9 LMN 18.Y7 RCW AND <br />298.200 WAC. <br />9qN�TUNEOFGONTqACTORORAUTNOXi2EU�0ENT O�IE <br />X �JJ /-3/-�- <br />11PPLIC CITYlVlINES7LIGENSENO��DBU91NE88N11ME <br />M[CHIINICAL <br />Np, TYPE OF EWIW <br />NC — NMNDLO UNITS — M.F <br />FORCED AIR SYSTEMS— flT <br />UNITHEATERS—&T.U. M <br />CLOTHESDRVEFS <br />OA9 PIPINO <br />E%HAUSTFAN <br />BUILOINO <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />STATE BUIL�INO 9URCHAROE <br />STATE ENER6V SURCHARaE <br />PUBLIC WORKS <br />TOTAL <br />8� ! <br />S <br />Y <br />0 <br />r <br />h <br />t <br />! <br />u <br />a <br />� <br />:1 <br />d <br />� <br />u <br />� <br />i <br />�i <br />R <br />9 <br />