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APPLICATIOrI FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•8810 <br /> f� DEMOLITION (1 COMBINATION OQ BUILDING �l MECNANICAL � � PLUMBING I I SIGN <br /> PROJECT ADDRESS 3�n� W. C!�-5 /Na JI-/,� �O•- �/� <br /> oWr+ER M�iI��L`rt155 cirv 7m rr�oNc <br /> 'r"(�-£ 13 asm�G C�. <br /> 1F.N�NT ��IUODNF55 f,ITY )iC P��ONE <br /> �30� /�✓c- <br /> ARGIIRF.GTOROF.SIfiNf� M�II�DfIRE55 UTv 71P PIIONF <br /> �oC'_ %�G - <br /> OENEfI�If,(X�LIUCIIXI M�II�ODf1E55 CIIV 7iP P�ION[ Si11tEIICENSE� <br /> G EN�it-irt� <br /> MfCN�NIC�I CONiRACiIXi MMl�DIMF.55 f.liV JIP P11CklF 511TF I ICf.NSE� <br /> PIIIMBINGCONfR�f,IOR MMll10URE55 CItY 71P 1'110NE STQf.LICF.NSE• <br /> CONIR�CT{'MCE Of Y/Of1N <br /> HEATING SYSTEM: I i GAS f 1 ELECTRIC f 1 <br /> pESCRIBE YYONN�ND SOU�PF FOOT�OE INVOLVED CONT�Ct PfR50N ANU PMONF NO <br /> ✓L�T/Lo<�m T2a, i�E� /E' x 6o G6'o�/.¢R.-J TL^n, ✓�a/Isi� <br /> I HEREBV CERTIFV 1HAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT ALL <br /> vaoroseouse ov emiaNa PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE Of <br /> WORK WILL BE COMPLIEO WIiFI WHF.THER SPECIFIED HEREIN OR <br /> ieoeioescmvvor�orrno�erris�awr+eeiowon�rt�ceTwoeoriesi NOT. THE ORANTIN� OF A PERMIT U^ES NOT PRESUME TO GIVE <br /> ioT BiaK a AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR IOCAL LAW REOULATINO CONSTRUCTION OR THE <br /> PEHFORMANCE OF CONSTRUCTION.THAT I AM AUil10(iIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> V�fILEL TIU(I D NUMBER CONTRACTORS LAW 1827 RCW AND 29620 AC. / <br /> CONSTRUCTd110�NlENUER.�[MN�ESS.TElFM10NENUMAEII ��� � � �/`�' I� <br /> [HN <br /> 5 �TURE Z OAIE <br /> CITY flU5WE55 LIC[NS[NO <br /> PLUMBINO MECHANICAI ' <br /> NO. TYPE OF flXTURE OR ITEM FEE N0. TYPE OF ECUIPMENT FEE <br /> WATERCLOSET�TOILET) � A/C—AMNDLOUNIT3—H.P. ' <br /> BATHTUB � FORCED A!R SVSTEMS—B.T.U. M E.A. ' _ <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLO?HES DRVERS � <br /> DISHWASHER � VENIILATION FAN ' <br /> UUNDRV TRAV � RANQE HOOD i <br /> CLOTHES WASHER WATER HEATER ' <br /> URINAL WOOD STOVE � <br /> �RINKING FOUNTAIN i METAI.FIREPLACE(WO00 BURNING) i <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKfLOW PREVENTERS � GAS FIREPLACE �_ <br /> SINK(SERVICE—BAR,ETC.) 6AS RANGE <br /> � OAS PIPIN6 <br /> E)(HAUST FAN ' <br /> � ' <br /> � �— i <br /> i <br /> SUB TOTAL E SUB TOTAL S ' <br /> PERMIT S � PERMIT E � _ <br /> TOTAL FEE S � TOTAL FEE E ' <br /> FOR OFFICE USE ONLY: <br /> f110NTSFiPACK AF�IISFTOAf.N SIDESETB�Ck PI�NCIIFCNNUMPfR fFf f1FfPIPINO <br /> uspioNF wren¢� ver,�HtsrtF FEES VALUATION FEE <br /> — iires i�� �o nunn�Nr, � �_ =_' <br /> nein�rt uMrt�noN No a nwruiNa s�ze or niocm ' � <br /> ur�ns riuumwr. ' <br /> -- ---r— <br /> _ — i <br /> OCCIIP�NCY NO M SIOBi[5 f%:CUP�NI LO�O P�SEMENt 4fO��NIf.AI � . <br /> rnnuv - - ------ ------ — <br /> IIYES I� HO <br /> �pp1110N�1 Pl�N CNfCN � <br /> 1 R1F�U�M OEO D �F�SON _ _-- ---�-- <br /> omen � <br /> �_ <br /> rIRFSPnINnIFnnFOn nFecpN — -- — ; X� <br /> Sut[nun Dwr,cunr.runaE ;.! <br /> ivrF cx r,pr�st rinNsnrrnovrn m CITV OF EVERETT runnc wonxc I <br /> LOCAL SALES ---- --- -- ---------�- '---- <br /> — —- <br /> ��a�� TAX CODE IS 3105 70TAL _�_ <br />