Laserfiche WebLink
��y <br />C � H <br />7 -3 fA <br />� �y � <br />q W O <br />�� N H�n <br />� H O <br />°zno <br />M M O <br />c� • n <br />zy� <br />� N y <br />j y FI <br />ngom <br />�a�tra <br />H O N <br />f�� Everpreen <br />CItY OF <br />everett <br />BUfLDING DEPAR7P-�ENT <br />259�II745 <br />❑ DEMOLITION <br />OWNER <br />����PPLIC�TION Fd�.. <br />C�NST'RUCTIO�I <br />PEk',MIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ COMBINATION <br />MAIL ApDRE`. <br />333 05 I S- <br />❑ BUILDING <br />5 <br />❑ MECHANICAL <br />CIiY ZIP <br />r-� w�( �i6ca3 <br />zir <br />❑ PLUMBING <br />PMONE <br />PMONE �"�'L <br />everett <br />� <br />y <br />MECHANIGLCONiNAC•TOfl MAILAOORE55 Cltt ZIP PIIONE LICENSE� <br />PLOMBINGGONIPACTOR MR�LAOORES$ Gltt ZIP PMONE LILENSE• <br />��V�Y1'Vnn <br />NEW ❑ ADDITION <br />� <br />JN ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N <br />Vql/lATl01 � OF WORK �CMO'ST OF MAiEFIALS PLUS LFdORI <br />w� <br />oesc i � woaK _ _ . <br />ioT_ <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THESAMETO BETRUEANDCORRECT. ALL <br />pqpTTACMF011RCOP1E51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GI'JE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PEF7FORMANCE OF CONSTRUCTION. <br />SIGNAT�EOFC�]NTRACiORORAUTMORIZEDAGENT DATE �• I�.� <br />ITS 1� �� SI��NSE NO. <br />ICAL <br />TYPE OF EOUIPMENT <br />AIR CONO. UNITS—H.P. EA. <br />FEFPIGERATION UNITS—H.P EA. <br />�O LERS—H.P. EA. <br />r.nc riocn nf. iiNITS—TONNAGE E0. <br />TOTALFEE S � I I S'TALFEE 5� <br />THIS PORTION TO BE COMPLETED BY BUILDiNG DEPT. PERSONNEL <br />;N FEAR SETBACN SIOE SETBAGH <br />PLAN CMECH NUMBF.q PLAN CHECN FEE <br />FEE RECEIPTNO. <br />' LOT AREA yp�qNT SITE FEES VALIIRTION FEE <br />� OYES �NO <br />_ ..�..��.,..��oeonim unniffWELLINGUNlTS _ _ <br />ACC �Y <br />OF SiOP�ES I MA% OCC <br />BY <br />ORISSUPNLEBY { <br />`�� I <br />BUIl01NG 5 <br />PWMBING <br />MECMANICAL <br />OTMER <br />PENFLTY <br />TOTAL <br />PdT-' <br />