Laserfiche WebLink
i� <br />�;^ ; : : <br />APPLiC 4''`�IAN FOR COI�IS�RIi�TION <br />PERMIT <br />� Ihe Everpreen <br />� GTY OF <br />everetl <br />! ever�t� � <br />� BUILDING DEPARTMENT <br />� 25 -�810 TO BE COMPLETED IN INK— PLEASE PRINT <br />�I NEIi M�IL�ODPE59 CIIY Zii' PHONE <br />.� �� SN l.�a�aooness / i/r ���1 �� CITY ����ZPi��` IPHON� ^�I/l � <br />TENANT- <br />I <br />; �_-_ � `DZ4��r�,`3C <br />�qGHIiECI�UN SIG ER RILADORESS G1Y ZIP PMONE <br />� <br />� <br />� OENEPALCONTR�CTOP MA�LpppRE55 q1Y ZIP PHONE LICENSE• <br />� ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSIOVE/FRPL INScRT ❑ BUILUING RELOCATION <br />.j TEN�NiIMPROVEMENiORIMENIOPREM00ELONLY COHTACTPERSONANOPNONENO. <br />I CANTR�CTPRICEOFWOPI6 <br />� DESCPIBEWOHKANOSOU�REFOOTAQEINVOLVED <br />� ,1�rAI��h '" 'r � <br />+ pnoaosEOUseo�'eU�lOiNo IHEREF3YCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND <br />. KNOW'HE SAME 10 BE TRUE AND CORRECT, ALL PROVISIONS OF LAWS AND <br />I ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />� LEdA UESC IP 10 OFPPOPERiY�SHOWN9EiOV/OPRTTpCNFOOflCOFIES� <br />LO1 BLOCK OF <br />PLUMBINO <br />OH ITEM <br />DISP. <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />�LLOWABLFUCTUAL <br />❑ VES ❑ NO <br />YY` � <br />❑Y <br />❑ N <br />WHETHERSPECIFIEDHER[INOF NCT.THEGRFNTINGOFA PERMIT0055 NOT <br />PRESUME 70 GIVE AUTHORITV 70 V�OLATE OR CANCEL �HE PHOVISIONS OF <br />ANV OTHER STATE OR LOCAL LAYV REOULATING CONSTRUCTION OR THE PER• <br />FORMAfJCE OF CONSTqUCTION. TH�T I AM AUTHORIZED BY THE OWNEfi OF <br />THIG PROPERTY TO PEfiFORM THE WORK FOR W HICH APPUCA710N IS MADE <br />AND I COMPLV WITH THE S7AiE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAG <br />SION�TUfiEOFCONTRPCiORORAUTNORIZEO�GENi OALE <br />�UYU�IGt 0%J1(����8. ��� <br />RPPLICRNISC BUSWESSUCENSEN0.4ND9U51 SSH�ME <br />MECHANICAL <br />PEE NO. �� TYPE OF EOI <br />A/C — A/HNDLG UNITS — <br />FORCEO AIR SVSTEMS— <br />UNIT HEATERS— B.T.U. <br />CLOTHES ORYERS <br />VENTILATION FAN <br />WOOD S70VE <br />ME1HL FIREPI <br />FIREPLACEIN <br />HEATPUMP �� <br />GAS P� <br />[XHAUSTFAN <br />$ <br />$ <br />SUB 70TA1. <br />"""` FEES VALUATION <br />❑ YES ❑ NO <br />NO.JFOWElLIN0UN113 BUILDING <br />PLUMBINO <br />OCG LOAD <br />MECHANICAL <br />NEioNtuMiurioN O7HER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHAqGE <br />PUBLIC WORHS <br />TOTAL <br />S <br />FEt <br />FEE <br />