Laserfiche WebLink
...... . . _ ._ ._. -. <br />_ ,� � <br />pppLlCi+ilON� PERRUC'T NSTRUCTION <br />P <br />fhe Everoreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />� v,�� �s <br />S/9� <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />�..� ZIP <br />]OHE55 <br />Q�� 2�� <br />�oness <br />� =--- <br />oor+ess / � <br />N <br />__-�--' <br />O�RESS �� <br />�v � <br />,4 Cio v� <br />� <br />i <br />� <br />everett i <br />e <br />z s y- 3 z �� ��.�� <br />:LASS OF WORN <br />❑ NEW ❑ ADDITION ❑ ALTERATION � F7EPAIR ❑ DEMOLITION co�ACW� p�ON�PN�/PIRONE NG ERT BUILUING RELOCATION <br />fEN�NT IMPROVEMEN7 OR INTERIOH F�ODEI ONIY <br />CqNTPACT PPICE Of WOPK <br />S��-c» <br />UE9CPIBEWO�F��VOLVEO I � CN ( � � —_ _ <br />J <br />ULENSE • <br />rnovo9EOU9eoFe aou+a IHEFEBYCERTIFYTHP.TIHAVEREADANDEXAMINEDTHISAYru�r�iurvAND <br />� r�r _/ tsy'�, Ly K KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br />�" OROINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED W�TH <br />OFAPERMITDOESNOT <br />� f Z S BLpGN '`� OF /�W"+'�� �/7� <br />ioi <br />rSr /�Gfo�l l7a/ �'� pli9 � <br />"30 (� Z 1 s--T' S T <br />PLUMBIN6 <br />un TYPE OF FI%TURE OH ITF.M <br />p��pWABIE/�CTWL <br />SPFINNLEflS <br />FEE <br />❑ res ❑ r+o <br />❑Y <br />❑ N <br />WHETIIER SPECIFIED HEREIN OR NOT. THE GRANTING <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />AN'D PRC�OMPTMTWITHRT�E STATEWCONTRAC ORSHlAWL1827�RCW AND <br />296200 W.4C. <br />SIGNALUREOFCONTR�CTOROHAUTMORIZEORGENT OATE <br />��'T - �"Z �'--�l <br />APPLICANTS CITY BUSINE55 LIGENSE N0. AND BUSiNE55 NAh1E <br />MECHANICAL <br />FEE NQ. TYPE OF EOUIPN <br />q/C— NHNDLG UNITS— H.P. <br />FORCED AIR SYSTf.MS— &T.i <br />UNITHEATERS—BT.U. M <br />CLOTHESDRYERS __ <br />VENTILATION FAN <br />RANGEHOOD <br />WATEA HEATER <br />W OOD STOVE <br />METAL FIREPLAGE 8 CHIMNF <br />FIREPLACEINSERT <br />HEAT Pl1MP <br />GAS PIPING <br />-- ExHAUSTFAN __ <br />ree <br />t <br />— — __. �---__—_—____ '. <br />—_ — -------� ' <br />1 <br />SUBTOTAL a <br />i <br />$ PERMI� <br />$ — I <br />TOTAL FEE $ ' <br />§ FEE pECEIPfNO. D <br />SIOE SF:TBACK PIAN CHEGR NUMBEfl <br />VACANT SITE FEES <br />VALUATION FEE . <br />❑ YES ❑ NO i <br />BUILDING <br />NO OFOWELLINGUN�iS � <br />PLUMBING _ — <br />I <br />t. occ �o�D MECHANICAL — � <br />HEIGHTIIMITAT10N OTHER I <br />i <br />STATE BUILDING SURCHARGE — <br />— i <br />STATE ENEfiGY SURCHAFiGE __ { <br />� <br />PUBLIC WORKS � <br />TOTAL <br />�, <br />