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AP�LICATIO� FOR CON�TRUCT�N PERMIT <br />CITY OF EVERETT • BUILDIN�> DIVISION � <br />3200 CEDAH STREET • EVERETT, WA 98207 •(425) 257-8810 <br />� DEMOLRION ❑ COMBINA710N ❑ SUILDING ❑ MECH�NICAL ❑ FLUtASN10 �f10N <br />_ _,.'LIf <br />•m�nr�roarrtwwrtn u.nwxwrtss cnr rm r�.r <br />dru-y77.74�/(� <br />wn cw.ia.c � u�n �ow[ss a. ��r r�xrvt sien irtrvu. <br />�i�M ''� �iy �s�(. �.�.s ��t� �Pi3y owi.v6�so��Nr / <br />MFCN��nC�l[[rvin�rlOn �ul�Op�E55 Orv M' 1��V�f tl��flK[usE• <br />1'11M1�16C�:1p1 N�tl�f11M1E55 bfY lM PM.T,F S���FIICEM${I <br />im <br />�r,r -� �vl� '. <br />[ONF1RlIClpN IO�N I FM1FR.1pIP[55'' <br />NITCH[N SINN 6 <br />HEATINO SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />cart�.cr Qnsw un rrqrr rq <br />/ OW�'I//�iT7v _ <br />I HEAEBY CERTIFY TM�T I HI1VE AE�D �NO E%AMINEO �MIS <br />APPLIC�TION AH� KNOW THE SAME TO BE TRl1E �NO fARRECT �LI. <br />PROVISIONS OF UWS AND ORDIN�NCES GDVERNMG iH15 TYPE OF <br />M/Oi1R WIIL BE COMPLIEO WITH WNETNER SPECIFlED HEREIN ON <br />NOT. THE GR�NTING OF � VEA1Mf OOES NOi PRESUME TO OIVE <br />AUiNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTNER ST�TE OR LOCqL UW REQUTATINp CpN579UCTNKi OR hE <br />PERFORMANCE OF CONSTRUCTION. THAT I �M �UT/qAIZED BY T�IE <br />ONTIER OF THIS PROVERTY TO PERFORM TNE WORK FOR WHKM <br />APPULATION IS MAOE AND I COMPLV WIiH THE ST�'fE <br />CONTRACTORS UW IB 2) RCW �ND Y96.200 W�C. <br />vy y 9B�_ <br />K .ivat � w�� <br />GfY Mi5N[SS l�Cf �[ �q <br />� TO1AlFEE f I I I <br />FOR OFFICE USE ONLY: <br />INT�tvIPKk Inf/.n5f1R�L[ SUFSF�B�Lvt A�NCII[ <br />S <br />IRFtOYL ^ � �IOt�uf� v�G�x�ylF <br />� �rEs O �.o euidwr. <br />��F�f.�1�1�MI��OOY I1NOCrUW[1111q <br />nuwma <br />�Y�Rnt vfcM�xx:4 <br />OYFS ❑N� �— <br />— �dMIttM4 fY1MC�KC� <br />OII�(N <br />{l11[ OU�IUMf S�IMu�MF <br />CRYOFEVERETT n�w�ir.ww+s <br />LOCALS�LES — <br />r�x cooe is ates roT�� <br />TOTAL FEE 5 � <br />r[F D � rrccnrtrq <br />v�iu�noH s�e <br />25c� � <br />_ _ ____'__—__i. <br />