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APPLICATI� FOR CONSTRUC�N PEf�MI'P <br /> CITY OF EVERETT•BUILDING DIVISIOIJ � <br /> 3200 CEDAR STREET•EVERETf,WA 98201 •257�8870 <br /> �I1 DEMOLITION I 1 COMBINATION iG BUILDING ❑ MECHANICAL Il PLUMBING '-�� SIGN <br /> IPROJECTAD�RESS <br /> I /�Ga /G^�,3RQh Adz <br /> m�n�cn uu�woi�ess urv � � <br /> r:orr_ .�� .�uWroccyr /ceca. [c„ti„L� ao� rv��rrr y9aoi 4a5. a,�. �s`ry <br /> ICNANI / . IAPIL�C/^.f1C55 LIIY ZIP /'If011[ <br /> ANCIIIICCi011�[$IG11Lf1���1.lAIL^�JI+ES�� UIV lII� PIKKI� <br /> GCI�aLCONIl1AClOP AIAll�D0�1E55 CIIV ZIG %YJIK SI�IELICLISE• <br /> MCCII>lIICALCOIII(iAC10� FIRIL�D�IIE55 CIIY IIV 911q1E $tAi[llrf��SE� <br /> GlUM11111GC0�1If1RL�Of1 �AnIIALCItE55 CI�Y t�� MqNE $I>ILL�GLIISL• <br /> comruc�rnweor v:onn7Z��np HEATINC SYSTEM: f�1 GAS f-I ELECTRIC I �. <br /> oe;cnioc�vonx nrio eooene rooure nrvaaco ccnucr rcnsor��im rrror�s rro <br /> �'FPL4�CE.,�C^�� nF ?�t F Fa.ah �o J . _ <br /> `� 8�� S h /�ICw A1'-FA WrcC 13� <br /> I IIER[OY CEOTIPY TIIAT I M�VE READ ANU E%AtdlflED 1MI$ <br /> U SF� F�L S1Q(Zqly�-_D^�L `� APPUCATION AND NNOW TNE SAfdE TO OF TRUE AND CORHFCT.ALL <br /> �norosen us[or nwmmu pqOVI510N5 OF LAYJS ARD OPDINANCES GOVER�mHG T HIS TYPE OF <br /> =/.J(yL� f�Aw1/G J�ESILk'._J. VlORN t4'ILL �E GOh1PLIED VJITH WHETHER ;PEGIFi[D IIEP[If� Ofi <br /> u�;nuitso���°�ionorrnortnrvca�o'wnnowunniw�.inwocorits� NOT TIIE GMNTMG OF A PERMIT DOES NOT PR[SUM1t[ i0 GIVL <br /> i�� ��d.3��iax 3SC �� LUCJ�E�'T AUTHOIIITV TO VIOIATE OR CANGEL TME PPOVI!:ION OF ANY <br /> ` OTHER STATE CR LOCFL LA'N REGULATING CONSiRUCTION OR 7ME <br /> ��V� S�Or�/ l � ,` PERFOAGIANGF OF GUNSTRUCTION.THAi I A�d Al1iHORIZED DY TI IE <br /> OWNER Of THIS PROPERTY TO PERFORid iliF�WORN FOR WMIGH <br /> APPLICATION I` MADE AND I C P Y/IYITH THE STATE <br /> vu�cute+� ri�mcn — CONTRACT SLAW1827RCWAG'Oy 2, YAC. <br /> -9.��-?r1��3J �y?��'3�- �1- � <br /> cot�s�nvcnoN lc W L[u�ER�Dun65,tLLEC�rori[NuuuER - <br /> si:riuun[ m�c <br /> cir oucn¢ss i�cu��.r r.� <br /> PLUMBING MECMANICAL __ <br /> N0. TYPE OF FI%iURE Ofl iTEM FEE NO. T�PE OF EOUIPIAEGT F[E_. _ <br /> WATER CLOSET(IOILET) !vC—A HN�LG UNRS ' <br /> �ATHTUO FORGED AIR SVSTLMS <br /> LAVATORV(N'ASH OFSINI HEAT PUM11P _ <br /> 51/OVJER UNIT HEATERS <br /> KI�GHEN SINK R DISP CLOTMES ORYERS <br /> �ISHWASNER AANGE h1000 <br /> LAUNDRY TRAY YlATER HEAT[R <br /> CLOTHES W�SHER �VOOD STOVE <br /> 11RINFL b1ETAL PIR[PLACE�WOOD OURNING) <br /> �RMHING POUNTAIN �IRLPLACE INSERT pY00D�URNING) <br /> FIOOF DP�W uAS PIREPL�CE <br /> OACNFLOW PREVENT[RS GASRANGE <br /> SINN�SENVICE—�AR,ETC.� ! GAS PIPMG <br /> E%N\UST FAIJ <br /> SUDTOiAL S $UOIOTAL 5 <br /> PERId1T 5 PERId1T S <br /> iOTALFEE 5 TOTALFEE 5 <br /> FOH OFFICE USE ONLY: <br /> fRO�If5U1PCe HL>IlSOIUCR Si�C5Cl0ACR � �UNC CNNV�16E11 � VCE �/ PECEiPIHJ <br /> Zo ' Zo ' �o' Stda � ;,, O/D/—G�� <br /> �tir_���i_ n � i�����i� �q�N�g�E � FEES VALUATION FEE <br /> �, I1� ^-�� ri�Es ll�� nuitouM. 3� <br /> 11L�GIII 1�1.111>l� � t!n(N IMLIl11M 512L W lllIXil l � <br /> IINI�$ I� S 1+1U41114lG <br /> IX:C.IIMNLY 1�p�)!$If�;$ f]C1:11fAl1IlOAp 04$[4�1N! yE����ry�/y � <br /> �.� ��3 <br /> 1 Lti 11 NO <br /> Mfli I ICNI{I�(NI CIIECY. <br /> �mesrmriuu�rrtoo nuscr� <br /> mo� <br /> nneaunun[oo n[esoq <br /> Surt Bmmrtp su�Crunc.E <br /> Fi'coico��sr nurrs�i•rrwv[nar CITVOFEVERETT rwi�c��aus � <br /> LOCALSALES --- � <br /> _�_� n,�� ZZ�;.p/ TAX CODE IS�105 TOTAL __�__ ___�_ <br /> !--• <br />