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APPLICATI� FOR COI�uSTRUC7�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />' 32�0 CEDAR �STREET • EVERETT, WA 98201 • 25&BB10 ��Mfll <br />❑ DEMULITION f� COMBINATION ❑ BUILDING C i�_ _:CMANICAI ❑ PLUMBINQ ❑ BHiN <br />PROJECTADDRESS:8421 Everr.reen fdav <br />47-1100/743-0737 <br />_IJilliam C. Arockcav 3216 We[mnre Ave. Gverett IdA 98201 'LS -fiH48/fnx 259_4742 <br />NtM�fLlp�Uf51GNEN WVIMp�E55 t�lv T�P qpH[ <br />T�D/Owner <br />acrcnKcaH�rv.crrn ruiww+css urv rm MaxE v�i[iwcnse. <br />T6D/Owner <br />WEp1AK�lCON�IUCION M/JLMqIF55 GIY I�P ��pNE SIAIEI�CEMSE� <br />T➢D/Owner <br />fYU1RNpCplIR.lCtd1 YYL��OPF55 GfY jIP PIqNE SI�IEII[Ex$E• <br />�� � <br />No work <br />room space <br />ior eiorx <br />stin� BuildinR <br />o s o o ,ce <br />unit kitchens [0 17 <br />ng use) <br />1ElEPIqME <br />FOR OiFICE USE ONLY: <br />rrorrtsern�rx�t r+� /� <br />. <br />USEIWE��/ Io1�M� <br />11EIGIIit1M1�110N NOOFpWFWtq <br />I1N1�5 <br />CIX'+.Cm�HLY 1qMSIM[5 CCCIMANItO�p <br />, _ �: �✓� <br />fIflESALNKLENlVE4'D RFASp1 <br />/U� <br />{IflENN1Mqf0'0 PF�iQV <br />e/) <br />� OA�E � � / <br />HEATING S1'STEAd: ❑ GA£ <br />�q[�IN:i"B\'� <br />��'m <br />u <br />I HEREBY CERTIFY THAT I HAVE READ AN� E%AMINED TMIS <br />APPLICATIDN AND KNOW THE SpME TO BE TRUE ANO CORRECT ALL <br />PRONSIONS OF UWS ANO ORDINNiCES GOVERNING THIS TYPE OF <br />WORK WIIL BE CAMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE CMNTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHOflITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTIIER STATE OR LOCAL LAW REGUUTIN6 CONSTRUCTION OR THE <br />PERFOPMMlCE OF CONSTPUCTION. TMl1T 1.1M AUi110{iIZED BV THE <br />OWNER OF THIS PROPERiY TO PERFORM 7HE WORK fJR WHICN <br />APPLICATION tS MADE AND I COMPLV WITH THE STATE <br />CANTMCTORSLAWiP27qCW 6200WAC. <br />r�i,.�., �.�.'!> �!1'a`�-S(o <br />e� 1 oe�e <br />GM1 &�y{55 tGFML MO <br />viu�n�[cxruue[n <br />V�CNII LfE FEES <br />Ow¢s ❑ � owown <br />s�zc a eioort� <br />� 5's� ��uo� <br />BlSEYENI � YFCNAY[/.L <br />pv[5 Q,q <br />•pplpN�l R W CNfCM <br />omen <br />5141E BUI�pN(151111CII�E <br />CRVOFEVEHETT niair.wonKs <br />LOCALSALES <br />�L TA%CODEISJ105 TO7AL <br />sueTotu s <br />PERMIT f <br />TOTALFEE f <br />rtr ircc�m�rw <br />a�•;. �� <br />VALUIITION <br />�1.000 . <br />