Laserfiche WebLink
�,' � y�� ,.,.., <br />APPLICAT :�N FOR Ctl►NSTRUC-�'iON <br />PERM17' <br />fhe Everpreen <br />CITY OF <br />e`.�erett <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK— �LEASE PRINT <br />i/ <br />�l_y�' Z <br />// // <br />evere�t <br />e <br />. -��� ur vNONE <br />UENEfl�ICONiRAGiOfl M�IUDD.iE55 CITY ZIP PIIONE LICENSEs <br />MECH�NIC�LGONTR�CTOR MAILADORE55 GIiV ZIp PHONE �I�ENSE� <br />J <br />❑ NEW ❑ ADDITION ❑ AITERATION ❑ REPAIR ❑ DEMOLITIOPi ❑ WOODSTOVE/FRPLINSERi ❑ BUILDINGRELOC TION <br />IEN�NT IMPPOVEMENI OF INiEP10R REMODEL ONLY �ONLACT �_RSON RNp PMONE NO <br />fANTflFCT PB�G[ OF WOAM <br />OG9 WORK�NDSUU�PEFCOTAGEINYOLVED — <br />�����;� <br />PROP09E�IISEOFBmiUrt� _ <br />LOT BLOLY, OF <br />' ! � PLUMBING <br />� � NO. TYPEI <br />7 WATER CLOSET <br />SINKB DISP. <br />HER <br />'TRAY <br />ROOF DRAINS — <br />SINK ICFRVIf:F — <br />SUBTOTAI <br />PERMIT <br />TOTAL FEE <br />ALLOWABIE/ACTU�I <br />Bi2EOF6LD0. NO.OF81 <br />t <br />RPE9PNINMLEPSpEO111R2D OYES O <br />MP4C�ilONAGGBV PL�N9AP <br />�� <br />I HEREBY CERTIFY THAT I HAVE READ F ND EXAM111NE0 THIS APPLICA'OON AND <br />KN01': THE SAME TO BE TRUE ANU COFRECT. ALL PROVISIONS OF LAWS AND <br />ORU4JANCES GOV[RNING THIS TYPE UF WORK WILL BE COMPLETE� WITH <br />WHETHER SPECIFIED H EREIN OR NOT. THE G(7ANTING OFA FEHMITDOES NOT <br />PFE3UME TO GIVE AUTHORITY TO VIOLA7E OR CAIJCEL 7HE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUC710N OR THE PER• <br />FORMANCE OFCONS7RUCTION. THAi I AM AUiHORIZED BY THE OWNER OF <br />TNIS PROPER7V TO PERFORM THE WORK FUR WHICH APPLICATION IS MAOE <br />AN� I COMPt.Y WITH THE S7ATE CONTRACTORS LAW ie.e7 RCW AND <br />296.200 W.4C. <br />SIpNATUREOFCOMNACiOROqpUTMURI`E��OENT O�IE <br />X �1 - t'%i�� .._, e / <br />NO. TYPEOFEOUIP�� <br />NC — A/HNOIG UNITS — H.f <br />FORCED AIR SYSTEMS — 6T <br />UNITHEATERS—B.T,U. M <br />CLO711ES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />a <br />s <br />a <br />❑ YES ❑ NO <br />' NO.OFOWELLINOUNII9 BUILDING <br />PLUMBING <br />BPMI. OCG LOAD <br />� � MECHANICA� <br />❑ N <br />HEIGNfIIMITATION OTHER <br />S7A7E BUILOING SURCHAFiGE <br />STATEENERGYSURCHARGE <br />� PU6LIC WORKS <br />TOTAL <br />sue rorn� <br />PERMIi <br />TOTAL FEE <br />VALUATION <br />E <br />E <br />