Laserfiche WebLink
APPLICATION FOR CONSTRUCTION <br /> fAs Ereryieen PE R M IT <br /> CITV OF <br /> rvrn•U <br /> evere e <br /> BUILDING DEPARTMENT <br /> 259-BBiO TO BE COMPLETED IN INK— PLEASE PRINT <br /> oW�� M•n�uor�fss Cnr ti� w�oet <br /> � �� � / �y,. ;7C10�/ <br /> re �r�� ���[-G�--llil- /�����- /ri, rT J.� .���-v71____.-2 <br /> MMl�DOPE55 GM1 !iV PHpNE -------� <br /> �IICMiTE6TORDE9�ONER M�iI�DORE45 GiY � ZiP VHONE <br /> � __.�_ <br /> >" t d.� .1 '� <br /> IER�LCOIIR�CTOR M�II�DOPFS9 CIIY IIP PNONE - <br /> IiCENSE• <br /> MECM�NiG�I LONiP�CTOR Meq�OUHES9 CitY zip - <br /> PNONE IICEN3E♦ <br /> MIIMBINOCON1q1CtOR M1p�DORF.95 Giv ZiP PHOHE <br /> �iCENSE• <br /> C1�99 Of NV RK <br /> ❑ NEW ❑ �UDIt10N ❑ ALTERRTIpN ❑ REPAIR ❑ OEMOLI710N ❑ WOODSTOVE'FRPL INSEPT ❑ BU'LOINQ qELOC�TION <br /> 1FN�Ni iMPROVEMENT OR INTER�OR REMOOEI ONV CONi�Ci Pf.R90H eND PH4NE NO <br /> ��, ' { � <br /> CONiR�CfPRICEOiNORK J'y I t��� . _-- -.y/, '����x`'—_� <br /> OElCR/iBE7WORM�NDSOU�REFOpT�OEINV�VEU�� S_i_i-��.�•+` Z.L� -- <br /> C t �'n ifi l/� . . <br /> vncoo9eous orew�oine ��-- -- ---.— _ ___ <br />' � I HEFFBv CERTIFV THAT I HAVE REAO AND EXAMINED THIS APPLICATION AND <br />� NNOW THE SAME Tp BE TPUE AND CORRECT ALL PROVISIONS OF LAW 5 AND <br /> LEWLOESCR�PTONOFPPpPERtt18NOWNBFowpp�n�CHrouRCOwE9i ORDINANCESGOVERNINGTHISTVPEOFWORHWILLBECOMPLETED'NITH <br /> RESIIME TO G VE UTHORITY O V�IOLA E OR CAINCE�L THEEP OIV SI�ONS+OF <br /> . � �Di� B�oGK Or � ANYOiHERSTqTEORLOCALL1WREGULATINGCONSTRUCTIONORiHEPER� <br /> j � FORh1ANCE OF CONSTRI�CiION TMAT I AM AUTHORIZED BY TME OWNER OF <br /> I �'�`�""'`,-. THIS PROPER7V TO t'ERFORIA iHE WOliK fOR WHICN APPLICATION IS MPDE <br /> ' ' - AN� 1 COMPLV WItN THE STATE CON7RACTORS LaW 1827 RCW AND <br /> 2nfi.POp WAC <br /> SIGV�IpREOGLO41NnCl,)nn4,„i�ry�qp�jE�AGENi Uqf <br />' PRf1JEGT�D�RESS � 1� --- _✓y,. 7�Kti"�(LYL. .__ / /� f C'� <br /> �/ 1�� �^�TTI � �PPUf.�ryf5 BUSINFSS�UCENSlNOANpBO5Wf55N�ME � �a <br /> ; �xJlf � <br /> I pWMBINO MECHANICAL <br /> I , <br /> i � � _NO. TYPE OF 1'UINRE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILEn A/C-�YMNDLG UNI75-H P <br /> �" � BATHTUB FORCED AIR SVSTEMS- 9.i U M EA <br /> ' LAVATORV�WASHdA91N) _ UNITHEAIERS-BTU - <br /> , SHOWER CLOTHES_DRVERS � � <br /> I KITCHEN BINK6 DISP. VENTILA710N FAN � <br /> _ DISMWA9HER RANGE MOOD � � <br /> i �AUNDRY TRAV WATER HEA7ER <br /> CLOiHES WASHER —��----��----- <br /> WO00 STOVE � <br />' URINAL METAL FIREPLACE 8 CHIMNEY <br /> _ _._..__ ___ __ <br /> DRINKINO FOVNTAIN FIREPL: 'E INSERT <br /> F�OOR DRAIN HEAT P�.!P — — --- --- <br /> BACKFLOW PREVENTEHS OAS PIPINl3 � <br /> FOOF DRAIN3-RAINLEADERS E%HFUST FAN <br /> 91NK�SERVICE-BAR,ETCI � �- - - <br />' _ —_ . —_ — _.._ <br /> � _- <br /> _ '_ <br />` - <br /> _ 9UB TOiAL S 9UB TOTAL s <br /> _ _ ___ —_ — <br />� PERMIT S PERMIT f — <br /> ...-- . . .__ _ ___ _ _ _._- ___ ._--__._ -_- <br />� 70TAL FEE S 107AL FEE S <br /> FRONi9ElB�CK ' REeRCEiB�CK � SiDE•E*9�Cn O�ANLH[ NNUMlEP f[E IICCEIRNO. <br /> r � � <br />� /O 5 $ 5ER5.�►�'� !�l c� � �� �L' l <br /> useroiv: �oi�ne� — wyEs�srtE � FEE9 VALUATION FEE <br /> IYPEGiGONSi occuwacror+ouo— � BUILDING ' ��/' �"> <br /> NO OF DWELI�Na tIN115 <br /> �LLOW�BLEdCiWI _---_ --._-- _ -______ L <br /> �M �-� --. PLUMBING <br /> 91ZEOf BL00 NO Oi810RiE9 09Mt OCL LOAp -'- -- <br /> �d, '�� � � MECHANICAL <br /> HEIpNTLIMIdTION OTHER �� L (/ �� <br /> iIRF9PRiNKlF.ASREWIRED ❑YE9 ' IIO - <br /> 'I ----- STA1F.B IIGING SURCHARGE _— �� <br /> S7FiE ENERGV SURCHAROE <br /> APPLIGTION�fCBV PUNS�PP119V -- ---'---'- ----. .-- --�--- - -- -.--... <br /> LII � � VUBLIC WORKS <br /> "� i _,�r � <br /> TOTAL <br /> i <br />