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APPLICATI� FOR CONSTRUC�N PERMIT <br /> CIN OF EVERETT•BUILDING DIVISION �. <br /> 3200 CEDAR STAFET•EVERETT.WA 98201 •(425)257-8810 <br /> '14?� <br /> ❑ DEMOLITION � COMBINATION y�( BVILDING ❑ MECHANICAI ❑ PLIiMBIN6 ❑ SION <br /> PROJECTADDRESS:�zI2 � �o�'�___ <br /> Ha�rnT toa r+ur+avm,s�scP �e.�x 153_�I�y wmq,����n C'_�fi���-!b?8 <br /> OwNA� vu��IXNFS� tm l�r Mrout — <br /> _pt,iuEE _ <br /> �[w�vr u+n uwnrss arv pn n.� — <br /> p/KfN9�.1 Aft�ttr�15 i7fh�y,��'���DR. �y�, wA 9Y1o1 _ •�.��25'�-3/LL__. <br /> •RLwTfL�O�bf4PU� un1�DfNi55 OIY /�v urt <br /> �'vL,1.�[�Z" <br /> GFNE�4CONVULICI� NUI��1�Of55 Cnv li� �vxp4f :4111�CIrv[{• <br /> '(}hl�.Irj?- <br /> MiC11�M1i(�l f.(lYf1��r�V� 4�i1�IFYIFS$ Clrv Irt' - � I'�Y,Ir�f [111(iICIN[f• <br /> -OiJI�C�� <br /> �IIIYBINGCON�R�f,l(N1 4Yl�GIWf55 CIIY lll� 1'I��'�f ' [I�if11CI�+5f• <br /> � IJn <br /> ��„�.«,.,,,«����. L�<3G.d -- �— -- <br /> HEATING SYSTEM: �9 GAS ❑EIECTRIC ❑ <br /> orsc�anv vnnn�rn mv.w itw�mt wvrnvm couucr�.rnm�.�vnn�ov�.�o <br /> aJ��'Sdv DUPc��X�+J� /1fPROx 22oJsi� Ft-1�4ErF oHN �D. ScHinr�R C1A;)5-06-8809(a��_— <br /> � �Zy)356-3466[�+�ti;Mrs� <br /> _�//�a'1�J F7" f�'3Z u�viT ..—' <br /> S��¢t�.E IL` "��IDEjJCE� I 'REGY CERTIFv THAi I HPVE READ AND E%AMINEO TMIS <br /> ouonasfo osr or ninmi.u� �7'� APP�iCAIION AND NNOW TME SAME TO BE TNUE 4ND LOFREL7 ALL <br /> PROVISIO�/S OF LAWS AND Ofi01NANCES GOVENNING TNIS TYPE OF <br /> WORK WII L BE COMPLIED WITH WHETHER SPECIFIFD MEREIN 9R <br /> IEG���o�es�cn9n'nworr'rorenrvisrhwneuawou�n niworon[Si NOT. iHE GRaNTING OF A PERMIT DOES NOT PRESVME TO GIVE <br /> iotSJ�-=eiotn 6�6 or r�� �='Q�R pV�s� AUTHpF9Y TO VIOLATE OF CANCEL THE PROVISION OF AN� <br /> OTHER 5TATE OR LOCAL LAW RECULFTING CCNSTRVLIION b:TME <br /> `�G�, pCCenD�N4 ia AIE PL'.T RLta'+DED �N V��, 4 PEFFORMANCE Of CONST�UCTION TNAT I RM�UT:IORIZEO BY iME <br /> OWYEh OF (MiS PROPER7V TO PEHFORM THE '.VORN FOR WHICN <br /> PIATS, ��[�[ �({� W 5��1�7("!SNLGUN(Y�WA, APP��CATIO!! IS MAGE AND I COMPLY WITH THE SiATe <br /> ru+Cn.uv i o m:uptn CONTfiA(;lORSIAW 1P 2:RCW AN�P9620C WAC <br /> 4374-61G.- Col -�2 ,l <br /> CCNCtR11C11(MIIO�HIfNMf1µNV1(551(l(IM!VfNVVRifI A. � �L��y� i99V <br /> � �/{— c.fA111 [ ^ ..- D��f <br /> — —/�l.i <br /> OM1 BII VN(SS UCf 1iiL k0 <br /> VLUMBING MECN�NIC�L <br /> NO. TYPE Oi FIKTURE ON I7EM FEE NO. TYPE OF EWIPMENT FEE <br /> jz , WATEP CLOSET�TOI�ET) �— U A/C—NNN�LG UNRS <br /> �" 9PTHTUB FORCEDAIPSYSTEMS <br /> � fAVATORv(WASHBASIN) Q HEATPUMP <br /> Q ENOWER O UNIT HEATGRS <br /> 'CHEN SINN 6�ISP GLOTHES DRVEHS <br /> UiS11WA5HER RANGE H000 <br /> O L/,VN�RV TAAV 'Z WA'lER HEATER <br /> CIOTHES WAS4ER � W00�STOVE <br /> O UFINRL 0 METALFIREPLACE�WOODBURNING� <br /> �F�N1(INGFOUNTAIN p FIREPLACEINSEP�pY00DBURNING) <br /> FIOOHDRPIN � GASFIREPLACE <br /> O GACKFLOW PREVENTERS 2 GASRANGE <br /> O SINN�SERVICE—BAP,ETCJ GASnIPiNG <br /> EXHAUSTFAN ' <br /> J_ <br /> _ a7 (i i <br /> SUB TOTAL S SUB TOTAL E <br /> PERMI7 f —��— 7EpMIT S <br /> TOTAIFEE S TOIALFEE 5 _�_ <br /> FOR OFFICE USE ONIY: (p 7.S <br /> rnoHlvrNrv arensrtP4t 5iM5tiB¢K r�exO4Caavwxrn rF a� nRPrtr�o <br /> --1r�_ io " __�1v9� �54 — <br /> uurorr im.n�. wc•�asu[ FEES V�LU�TION FEE <br /> � ' _�_ <br /> - ❑res ❑m� y�mm��� _ 129 3'� �0 7S ' GYJ <br /> — __ � <br /> �mnnnw n9., a-a a uwr u�.c s¢eoreiocn� , <br /> /� ur�is �`�7 � ru�w �q —._'__ "_— . _____" ..-.-�� �d� <br /> V <br /> CCLIII`n\'.;� 4��•�.;.a!> V(:(�ilun1101D 9�ifM[��1 / ^� i�J <br /> C�OU� q / 411�.�+..1..1 � <br /> � [� ❑�f5 6�� —..------ - -�-- -� -- ,�/� <br /> ��u�s� ���,.iei�i�eoo_—_ n�.scw •no�u.:un�c��rc. _ __ _.11_��� <br /> un•pn _ — _ _ <br /> �in�<wr;�uir�„— - ar.sn— —'— __._— ' <br /> cl.11 PI�.N�I'.!�InC�lnn:if /_ '(' <br /> .. _._. ll'_'U� <br /> nrrnrr�rinr��rreinvrnor � CITYOFEVERETT ruxu�:won.c ��7;�-��� <br /> —}� LOCALSALES <br /> _,1('/./ o•�F D - � pj TA%COUE153105 TOTAL (n�J ;� <br /> _ ___ —'___� <br />