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APPLICATIO� FOR CONSTRUCT�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 9B201 • 259-8810 <br />❑ DEMULITION ❑ COMBINATION , ❑ BUILDING ❑ MECHANICAL p PLUMBING A9�SIGN <br />. �.«. �. - � ....,�.� ..a., ,�, , r , �a ii -.�a .� � z-io�. <br />t ruN� uuuoaicss cnv �m rnoric <br />•nnu�ttrono¢smN[n uuiaconess ntt �ii•'- ruoee <br />GEqEn�ICOMIne�IM � Meh�O[Oc55 � _ Lnv _� )n� PUOxf 5f��[LICENSE• <br />, 1'WUBMGCONi11A��OB M/JV�CO11E55 CIIY !�N �I�ONE $lAfELIGEMSE• <br />LOi BLOLM1 <br />, LdISIPUC11pNl0ANLENDE{1,Ibq1E55.iFLF1'llpl[NIIMOEfI <br />WATER LLOSET <br />URINAL <br />FOR OFFICE USE ONLY: <br />IODNTSEI9ALN 1 PG�O: <br />2� `J9•Su: <br />USEIQ4E 101AO <br />` I i <br />H¢icr��yuiunoN , Hoa <br />owtuiNc <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />1 HEREOY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COARECT ALL <br />PPOVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIEO WITH WHETHER SPECIfIEO HEREIN OR <br />NOT. T!{E dRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUT110RITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEH STATE OR LOCAL LAW pEGULATING CONSTRUCTION OR THE <br />PERFOFiMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS P(70PERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MAOE ANO I COMPLY WITM THE STATE <br />CONTRr1CTOP5 LA IB27 RCW AND 296200 WAC. <br />�.iin�/�.0 LtY� 4�^4��% <br />VpU9NE55lKEN$ENO <br />ueaiawcn� <br />N0. TYPEOFEOIIIPMENT PEE <br />5 <br />frDE5F161.CF 1'IANCIICCRNII <br />io S / <br />vncnNt Si�[ FEE <br />Ores Afl:o omwnm <br />�r omGm <br />nuomHn <br />BASEHENf HFOuwGI <br />❑YES O„O <br />AOpll(1N�1 1`I�IICIIfLM <br />OI��EO <br />$ILIF OIIIt01Nf.511nLIPtlGE <br />CITYOFEVEflETT rum¢wonKs <br />LOCALSALES <br />TAX CODE IS J105 70TAL <br />fEf <br />��• <br />5 <br />