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APPLICATI� FOR CONSTRUC7�N PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201•257•8810 <br /> ❑ DEMOLITIQN G COMBINATION Ll BUILDINO ❑ MECHANICAL ❑ PLUMBINd ❑ SIGN <br /> PROJECTADDRi°SS � �„I�_�t� <br /> i�, � RocK�e EoE2� �ilA -9g <br /> 01yNER M111pp�C55 LITY IP �'IMI�< <br /> errN � E�ml �ANi..sfZ Z3ZD l03'� sr s.w. Evee_a,r H38-85�s4 <br /> ifN�Nl M�M1/.OMC$$ ���� �P p�� <br /> •11LNiiCPOPMSGNCR MMUfM+n[55 C�tY ZT FM/'iE <br /> OCNEI1nLCONiP�GiCR Y�R��.F�' [55 biY IP MI�G Sl�iEI�LEIYCr <br /> YFCM�NC4CONin�QON 4ullppRE55 PtY I�P Rq11E SleIElKEHSC• <br /> RIIMBIII6LONIRI.LI(NI Y/AL�OJRC55 CIIY IM AqM[ $i�iLLICLN$f� <br /> con*aecrPeccorvmn. HEATINGSYSTEM: ❑GAS ❑ELECTRIC Cl <br /> ,r. <br /> �[$L�IPENVrIM�NL50VI.FElWl�CfIHYUYIO 01111IiC(PSpN�NDA1.TyE^IQ4ml ��� <br /> �{�ti nP RF <br /> �ar� ���ncL s�+� - <br /> I HEFEDY CERiIFY THAi I HAVE READ AND E%RMINED TXIS <br /> APPUCAiION AN�KNOW THE SAME TU BE TRUE AN�CORRECT ALL <br /> r�wrosm use a eun�nr. PROY�SIONS OF LAWS AND ORDINANCES GOVERNING TMIS TYPE OF <br /> WORK WIIL OE COMPLIED WITH WHETNER SPECIPIED HEREIN OR <br /> ii�µp�uniptroearvap¢ntrbrowHeuowonen¢Mtwacaw[s NOT. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> Lor &«� � AUTNORITV TO VIOIATE OH CANLEL THE PROVISION OF ANV <br /> OTMER STATE OR LOCAL UW REGULATING CANSTRUCT�ON OR THE <br /> PERFORMRNCE OF CONSTRUCtION.THRT I AM AUTHORIZEO BY THE <br /> 01YNER OF THIS PROPERTY TO PEPFORM T4E WORN FOR WNICH <br /> qPPLICATION IS MAOE A�D I LOMPLV WITH TME STRTE <br /> CO`1TRACTORS UW IB37 RCW AND 496200 WAC. <br /> �""t�'S�"�cr$O70a70Q��- x_ �.oN.. �I.b,. �"17-06 <br /> LONSinVCiplll�l�N IENMR,MCPLSS.ICl[PHJNE NUI.IBCR <br /> SM.N+iUI'E D�IE <br /> fiiY[USINESS 1iG05[NO <br /> VLUGB�NG MECX�NICAL <br /> NO. n'PE OF FI%TUflE OR ITEM FEE N0. � TYPE OF EOIIIPMENT iEE <br /> WATER GIOSET ITOILET� , A'C—ANNDLG UNITS <br /> OATM NO Ff RCED AIF SVSTEMS <br /> LqVATORY IWASN�ASINI HE�TPUMP <br /> SNOWER �NIT HEATERS � <br /> KITCHEN SINK fl DISP CIOTNES DR'/ERS ! <br /> DISNWASNER RANGE HOOD <br /> LAUNDRV TRAV VlATEP MEATER <br /> CLOTHES\YASMEP W000 STOVE <br /> URINAL 1.1ETr1L FIFEPLACE(WOOD BIIRNING) <br /> ORMNING FOUNTAIN FIREPLACE INSERT pY00D BURNING) <br /> FLOOR�FAIN GAS FIREPLACE <br /> OACNFIOW PREVEYTERS GAS R�NGE <br /> SINK�SERVICE—BAR.ETCJ GAS PIPING <br /> E%NAUSTFAN <br /> i <br /> SUBTOTA: 5 �i SUOTOTAL S <br /> PERMIT 5 PERMIT S <br /> TOTALFEE 5 TOTAIFEE 5 <br /> FOR OFFICE USE ONLY: <br /> fNONtSElO�Cx PV>SCIB�Cry S�ESELB•CC 1'UNW[C6NUM9 <br /> iEE PCCC>iM <br /> �G •_O � `_% '�c�c� �Lj -1� <br /> use ve 1 iouw. ��c.xrsrc FEES VALU�TION FEE <br /> i, IJ '�v�s �wfo e�ronu � I <br /> II . <br /> r�ucrnom�na� uoaowcwxc svcoro�ccn —T <br /> �'�,�. vmrs � Sl / rwuemu <br /> r <br /> OCLII��Iti.Y N.lIXSii�tS IX:CU✓�NilOb 015fMlM1i MCCN�NC4 <br /> oov <br /> ��� nr[5 r o <br /> AW�iR,`N�IMNCNCCR <br /> fIRfS�RiMl�11N[00 RE�5011 I <br /> OillC1� � <br /> fI11EMAnu,PL00 PL�5011 <br /> SI�iE BN.�iNG SV11C���AGE <br /> nrcovcor:�i rti.r�s.nmov�oar CITYOFEVEflETT �ei��'�"^s <br /> ,� I � � LOCPLSRLES <br /> '�J �,a�i /7: /p0 TA%CODEIS3105 TOTAL <br /> _1=� <br />