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APPLICATi�N FOR CONSTRUC�ON PERMIT I <br /> CITV OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETi,WA 98201 •257•8810 <br /> � �_?9Gln � .. <br /> ❑ DEMOLITION O COMBINATION � BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PHOJECT ADD ESS <br /> �' ��o i�$��3`i `�'� cS�. V-f l�l}�' cS'�1"D l <br /> own[n M�K�ooness nrv zw vna�e <br /> ��r.lc �h o�e.)a,r G9/9 �'ie�vio� � Q,ut y'�y,(p� 9k�0� �>t S 33 �- 53 5"1 <br /> T W E55 CiY IW PHONE <br /> rnurn rnnfl.� iN�9f� N� 95`�'� �t ���� 9 DS�yas. �g�. yy�a5' <br /> nnamccron ESiGI�EfI niuoo ¢ss ci*v zw PI�WIE <br /> ���a_q_�f�frvkt.�l�r�ihi��i� IZII .�ikidlQuC�lOd �'ea,�/d %,I'/2Z ��Dla •.?� <br /> cmuuicgrt ecron r.u�uoone,s itr �/�� <br /> z r��a+e •Ei�[r¢E� <br /> �!� �S$6'S N U�T�LG£D't�i � <br /> GC /J!I A��ONiqAC.Jp yq� IIESi. + CIiY � tp RIONE � SLREOCENS[• <br /> ��A V f9i1 �yyirin��ral���f7n / �i27 /�/ '{/���i��-{7n-�L,�.�� ✓�.GN� �5�2'33 <br /> PLV BINp�ONLPALTOB MMAODf1E55 Clrv im PI�ONE SUIELN:b�SE� <br /> CONIIUCt pqILE OF N9N( <br /> � • � HEATING SYSTEM: ❑GAS ❑ELECTflIC �1(� <br /> DEvCR10EWd1N.WO5WNIE p'JIAGEINVQV [pNlnCiPFJ15q�A1I,�1pXpry[ <br /> /O�gca�,(Lr1 �n e1�Is��nu 120 ' �19��7A��Ra � -a.f.� �oul� ZDl� �z��r29d� <br /> � <br /> �P��9-9 I HER[gV CGRTIFY THAT I HAVE READ ANO EhA1dINE0 THIS <br /> r�w^[o e ev Cc i.mn %.i�"rLICATION AND NNOW THE SAME TO BE TRUE AN�CORRECi ALL <br /> PROVISIONS OF LAVIS AND ORDINANCES GOVERNP�G TH�S T'PE OF <br /> IEJN.'Ei Pi/i:OJJFVlICV q Y�SMOWNBELOWOflARILNIWOCOPIES) ���ORK LYIIL DE COMPLIED WITN WMETHEP SPECIFIED HEREIN OR <br /> NOL THE QRANTINQ OF A PERMIT DOES NOT PR[SUbtE �O QIVE <br /> 1O�— o��K ,y �F RUTHOFIITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> (` M PEfiFOR IANCEOOFOCONS RUCTION.THATIAMAUT ORI EOBYTHE <br /> OWNER OP THIS PROPERTV TO PERFOPIA THE WORK FOR V�HICH <br /> APPLICATION IS IdADE AND I COMPLY WITH THE STATE <br /> rui'E�ezio.uuuoen D D COM�C LAWf 27 CWAND2882[qWAC. <br /> /� <br /> C94^LI1VLilONLOM1LE1qC11,AW�[SSJELEPIroNGINWEO x ��^n/ <br /> IME _ pAiF <br /> CiIY OUSM[551C[NSE N0. <br /> 1'W M1731rJr. MECHANICAL <br /> _NO. TYPE OF FI%TURE Ofl ITEtA �EE N0. TYPE OF EOUIPlAENT FEE _ <br /> _ WAT[RCLOSET(TOILEn � A/C—A/MNDlOUNITS <br /> _ DATNTUO FORCEDAIRSVSTEMS i <br /> _ LAVnTORV(WASH BASIN) HEAT PUMP �— <br /> _ SHOWER i UNITHEATERS <br /> NITCHFN SINH 8 DISP I <br /> I CLOTHES DRVEflS � <br /> _ �I51{yyqSliER RANGE HOOD <br /> LAUNDf1V TI7AY WATER HEATER <br /> CLO i HES WASHER Y/OOD STOVE <br /> _ URINAL � METALFIREPLACE(WOOUBURNING) <br /> i <br /> DRINKING FOVNTAIN i FIREPLACE INSERT(WOOD DUPNING) j <br /> F10047 DRAIN GAS FIREPLACE —�— <br /> �ACNFLOW PREVENTERS � GAS RANGE � <br /> SINH(SERVICE—9AR,ETC.) GAS PIPING � <br /> — � E%HAUST FAN � <br /> I � <br /> i <br /> — � i <br /> � <br /> SUOTOTAL S i SU9TOTAL S � <br /> PEflM1T S � PERMIT S � <br /> TOTALFEE 5 ' TOTALFEE E ! <br /> FOR OFFICE USE ONLY: � <br /> flIONfSElOACN PEAPSEf9.1Clt SI�ESEIEACK p�AIICnECNM1YlEB fEE �J� RECEIPiVO. <br /> J <br /> use:ouc Loienu vec.wTSi.e FEES VALUATION FEE <br /> ❑res ❑'ro ounown . fi^5/ Z <br /> N[iGlrtl�Nii,lipN Hoorowcwra 5¢E0�9tpGrt.t <br /> UNIiS — <br /> rtwena <br /> CCCUPNICY IpCi510HY5 CCCVVANfLOAp OASFMENi NECIW ' C <br /> GOOUP <br /> ❑YES (]Np <br /> MESPILYFIERPEOD REASON MDRKKULPWIq1ECR <br /> FUIEAIA11MpF00 OPI[N . <br /> NE�SON <br /> 6iAiEBURWq6VIKlIMOE � <O <br /> TYPEOF ON Th � <br /> Gy�y vw+s�cv7�coor CITYOFEVEqE1T ruoiKwwixs <br /> � (�'3 . ��� LOCALSALES <br /> wrE R'1�1 TAX COOE IS 3105 TOTAL `v.-J�- �5 <br />