Laserfiche WebLink
i <br />� <br />�r, M�-►+A�+��', <br />APPI.IC�rt�ON FOR N <br />PERMIT <br />M� Ev�ryn�n <br />cin oF <br />everett <br />BUILDING DEPARTMENT <br />269•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />CITY ZIP VHONE � <br />� M�ILApORE55 Q - . � <br />..1f91/� ��Slo'1. MCS�i.ond �21'Z°� -l$v�� v�'�'��'�-�i� - . <br />��� ��� CI1Y ZIP PHONE � <br />��t MAILA�URE53 \I • �� � � � <br />ARCHITECT OR OESI(INER <br />M�IlA0DPE55 CITY 21P PMONE <br />OENEMLCANTiIACIDR MARADORESS CITY ZIP PMONE , ULENSE• <br />everett <br />e <br />❑ NEyy ❑ AODITION <br />OF WORK <br />�p{ BIOC Of <br />pWMBINO <br />� <br />e <br />� <br />I-1 ocoeia ❑ OEMOLITION ❑ WOODSTOVE/FRPLINSEiiT ❑ BUILCIN6RELOCATION <br />or <br />❑N <br />� <br />O YES ❑ <br />I HEREBY CERTIFY THAT I HAVE RGD AND EaAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE ANU CORRFCT. ALL PAOVISIONS OF UWS AND <br />ORDINANCES GOVERNIN6 THIS TYPE OF WORK WIIL BE COMPLETED WITIi <br />PRE UMETOGIVEAIITHORITY OV�IOLATEORCAINCELTHEP OIVISI�ONSOF <br />ANY OTHER STATE OR LOCAL LAW RE�ULATING CONSTRUCT�ON OR THE PER• <br />FORMANCE OF CON51'PUCTION. THAT I AM AUTMORIZED BV THE OWNER OF <br />AND IRCOMP VTWITHRTHEMSTATE CONT AC�ORSHLAW�iB27�RCW AND <br />296.2J0 WAC. <br />SIOH�7UREOFCONTR�G70RORAUiHOPIZEUAGENT D�TE <br />X%Un 0 H kl 1' �J� ��,1.,�/1 �/ �-, ���'-�' �0/i�i <br />�P IGANiSG1TYBU51 E55 IGENSENO.AN�Bl1SINE55N�ME <br />MECHIINICAL <br />NO. TYPE OF EOUIPMENT <br />NC—AIHNDLG UNITS— H.P. <br />FORGEDAIRSYSiEMS—&T.U. M <br />UNITHEATERS—&T.U. M <br />CLOiHES ORVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER _ <br />WOOD STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACEINSERT <br />HEATPUMP _ <br />� OAS PIPING <br />ExHAUSTFAN <br />FEES <br />BUILUING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENHRGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />TOTAI <br />FEE <br />, r�, 1 .. .. . . . . . . . �. . � . ., .: ., . .. . . . . . . . . � .� - <br />