|
�1
<br /> t . , ;. �' �FOR CONSTR�TION �� �-��r � ,.
<br /> ` ��' '° '�APPLIC�ION<
<br /> ° 1. . . . . . . ,.
<br /> . PERMIT ��
<br /> tM ron � . � everett A;�
<br /> .. Of " � . . . . . . - � �
<br /> `e�erett . . _ . , . :. . �
<br /> : . �
<br /> BUILDING DEPARTMENT <
<br /> 26F8810 TO BE COMPLETED IN INK— PLEASE PRINT as�- ao ay �;
<br /> ,�y� /1��..r��e�ccs 1 �3�. F /�7a��:�e V,'�w Dh E✓cr� lF 94�.D1 _ ,
<br /> M/JL�DDRE6S QTY ZIP PNONE �1 ��7`.•
<br /> •-ir��.' : IY.
<br /> '.4.1�A;. . _ . . .� �-�
<br /> P
<br /> ' 7iNN. .._ MAIL�O�RE55 GIiY ZIP � PHONE . . . . � �� NI
<br /> .T , . .�i ...�;1:' ._.� -� .�.�1 �:
<br /> '.�i�..�L........ _ . .
<br /> �`
<br /> �:!AONREQORDEBIONER MAlll1DDPE33 GITY ZIP PHONE . . : � . ' ,) . N:
<br /> Yerry�/)'J�,/;a�c<S 133.2 E lYlor��e V��c.,., Or l-✓eicff' gSl�.OI �5$- a.0a2�( . . , . �y
<br /> �E� �pR ' MAIL�DDHESS CITY ZIP PHONE 4CEN8E• � {fl
<br /> _, ,. ; i�4_., �,-� . ., .'� �a:
<br /> ,yECH/�NICAICONTMCTOR ' �IADDPE35 CITY 21P PNONE . .LICENSE• �1
<br /> .. _;i'; .. .. ,o�j kx:
<br /> , �]i„'....._,.-. . ��.• � .
<br /> lIYMMNOCW�TRACTOR AWLAUDRE88 GITY ZIP VNONE . .J J�•::LICEMOE• �.t
<br /> �q::;'!�1...;,'_ . . . . 5'�
<br /> � �'y
<br /> �•❑�N!W ❑ AD01710N � AITERAT10N ❑ REPAIR ❑ DEMOUiION ❑ WOODSTOVE/FFPL IN9ERT ❑ BUILDINO RELOCATION �� "' ' � �� E6��
<br /> IMNT DAMqVfMlNT ON INRRIqi REMOOEL ONIY CANT�GT PER90N�ND PHONE N0. 1'l
<br /> ,pW�iMCTM1ICEOFWORK RC J�C�'A nt � �G �s�J �
<br /> �[Wplll(/J/DOOWIXE �OEINVOWEO � �t
<br /> '.�h:,.: � _ , S
<br /> ... .5�., /� d�„�I ,� . _.
<br /> ,r�orw[ousi waaNa IHEREBYCERTIFYTHATIHAVEREADANDEXAMINEUTHISAPPLICATIONAND ��
<br /> ��-�`"�""'`'r� ' - KNOWTHESAMETOBETRUEANDCORRECLALIPROVISIONSOFUWVSAND �� , a
<br /> j�t.,\;�'�. . . :
<br /> p(�(',I��pflpNpFPROPEpfY�BHO`M/lELOWORATf11GHfOURCAREB� ORDINANCESOOVERNINGTHISlYPEOFWORKWILI.BECOMPLETEDWIhI' �
<br /> �`'`.p�,;;�" ' � • n�. � PF SUMETOQIVEAUTNORITYTOVIOUTEORCANCE�LTH�PROV1810N90F �
<br /> '���` � x�CK oF pNYOTHERSTATEORLOC�AI.LAWREOULATINOCANSTRUCTIONORTHEPER�
<br /> '=�j�..,-�. FOHMANCE OF CANSTRUCTION.THAT I AM AUTHORI2ED BV THE OWNER OF
<br /> �.;{��^�,r,,. � - THI3PROPER7YTOPERFORMTMEWORKFORWHICHAPPLICATIONI9MADE
<br /> AND 1 COMPLV WITH TNE STATE CONTRACTORS LMN 1827�'RCW AND 5
<br /> ::.5 ;:.'i,.,� 299.400WAC. .
<br /> '}i�r, NF�, ' � � &ON�TUREOFCOMiUCTOROR�UTNONRE0�4EHT OATE .
<br /> yb �' . �/ � / �
<br /> Y) ;.., X �
<br /> d � �/�7 n�_ nl �/IB. OA i �
<br /> FlIOACfMU11ElD � APPL N Y N �CEN ENQ� B INE '
<br /> s...:t'�� � ��,
<br /> ' � rL{IM�INO .. � MECMANIC�L „
<br /> � ��ryp, TYPEORFlXTUIIl0111TEM FEE � NO. TYPEOFEOUIPMENT �E ,.
<br /> "'"" 'WATERCLJ9ET(TOIL � A/C-IVHNDLGUNITS-H.P. �
<br /> "�•;tyi- =g�TMnB FORCED AIR SYSTEMS-B.T.U. M EA - �
<br /> �'!'.,:°:1'�`1' �LAVATORV A9HBA31M UNITHEMTERS-9T.U. M �•
<br /> ';7�+. �ar BHpyyEq � � � CLOTHESDRYERS
<br /> •�':'���SI' ��KITCMEN 91NKa DIBR � VENTIUTION FAN
<br /> �t
<br /> �r:- ��=�` �DIBHWABHER � RAN�E HOOD Y
<br /> '� � rLAUNDRVTRAY WATERHEATER
<br /> � iCLOTHEBWASHER � WOOD8TOVE
<br /> �URINAI� � � � METALFIREPLAC[BCNIMNEV
<br /> "�DRINKINOfOUNTAIN�' � FIREPLACEINSERT � �
<br /> �FLOORDMIN � � • ' MEATPUMP
<br /> •"' 'MCKFLOW PREVENTERB � � OAB PIPINa � .
<br /> '�`�""=`�� �ROOFDMINB-MINLEADER9 ' EXHAUSTFAN � d
<br /> '^'`Y��' BINKBERVICE-BARETG) ,
<br /> 'tfie:!q:� � - • . .
<br /> e
<br /> ' � SUBTOTAL S SUBTOTAL S
<br /> �� PERMIT S PERMIT S
<br /> � " TOTAL FEE S TOTAL FEE S
<br /> pppqi9ETgi101P pEAp5Ef9�CK SIUESETB�ICK ►tANCNECKNUMBEII FEE • 11[CEIRNO.
<br /> �
<br /> UlEZONE ' ' LOTMEA V�CANTSITE FEEB VALUATION FEE �•�
<br /> 0 YES ❑NO
<br /> �� ' BUILDING ' �
<br /> iy►60fCON8L OLGUMNCYOBOUP NO.OFDWELLINOUNITB
<br /> 'LL���' u'� PLUMBINO i.
<br /> . /�(p/gpp NQOFBTOHIE9 BSMT. OCGLO�D )
<br /> � o v MECHANICAL
<br /> ON
<br /> . . MEIOMTLIMITQION OTHER
<br /> FIRE9VRINNlEH9FE0UIPED ovES ❑no STATEBUILDINGSURCHARGE �
<br /> � � - STATEENERGYSUFCHARGE �
<br /> "�iRiGT10N�CGBY . PLANBAPPRBY � {>UBUCWORKS
<br /> TOTAL ��'" pp�
<br /> L�
<br /> ,r���. � . • {•.,
<br /> �
<br /> �w��wix.+:�TM,N4.. '�.h,l� . ��
<br />
|