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� � <br /> APPLICATI��1 FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-Fi810 <br /> f7 DEMOLITION fl COMBINATION fl BUILDING n MECHANICAL r� PLUMBIN(i g�pN <br /> PROJECT ADDRESS ��� u�j,,!rT � <br /> r/ W � <br /> °�q Mu��ooness <br /> /t�,K.. � CITY IIP PNpNE <br /> i•r• r�• I . Eub�tl 01 s ` e <br /> TEIUNT MAILADppESS 7S`� �I <br /> `}'� ��TY ZIP FNONE <br /> ��MT�TORI�SIGNER / � �� � <br /> _ 1. I���� p CITY 21P PHONE <br /> u� �/�Q�ocr+�ss��l ��� /ULC �o� �$',`� ��� "���J.Sr <br /> �au cor+m�ct <br /> �������_I�� I �� CITV PIIONE $TATE IICFNSE� <br /> •_n 11 M/ �,bl�Mf Ar sEATTiE z 9�P/�9 Zd1-d7A� �}� <br /> ���CkCONTq�CTtM MAllaDd1E55 '—'–`— �OSCS+�+/Z <br /> CITY ZIP IIONE <br /> S7�TE LICENSE� <br /> �U���Tp�T� M�IlA00qE5S <br /> CITY ZIP PIIONE <br /> STATE UCENSE• <br /> CONTWICT PfMCE OF <br /> 3o�p� NEATING SYSTEM: C-I GAS f�ELECTRIC f� <br /> ��lE WpIK AND SOUARE FODiME HlVOIVED <br /> C �`. ,c ",- ��" CONT�CT PERSON AND PHpHE N0. <br /> f�L"" r..w�l <br /> �� ¢� • S w1Kt� <br /> �`sO �"��t °��N( h�M'�I+�NMMw✓�✓£ey✓q I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> cFa�oseo use ov eu�drvo APPLICA710N AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � p( , PROVISIONS OF I.AWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �EMlOE�qIPTTKINNOFPiqPEpry�gqy� ��pyypq�n�N��Es� WORK WIIL 8E COMPLIED WITH WHE7HER SPECIfIED HEREIN OR <br /> wr �op, � NOL THE C�RANTINa OF A PERMIT DOES NOT PRESUME TO aWE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL Lpyy qEQUUTINO CpNSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOpIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WOqK FOR WHICli <br /> APPLICAT IS DE AND I COMPLV WITH THE STATE <br /> PMCEL TA%I.O.MlA1BER CONTR S L 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION lOM!LENDER.�WRESS.7ELE7NONE NUMBER <br /> - �„. �- i 96 <br /> D�TE <br /> �� GTY BUSHESS LIC SE NO. <br /> �p� TYPE OF FlXTIME OR ITEM MECHANk;AL <br /> WATER CLOSET(TOILEn �E NO. nrpE pp��T �E <br /> BATNTUB � MC—A?iNOL0UNR3—H.P. , <br /> ' FORCED AIR SVSTEMS—B.T.U. M E.A. �— <br /> LAVATOqY(WASH gAS�N) , HEAT PUMP � <br /> �WEp ' UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS , <br /> DISHWASHER VENTIlATION FAN � <br /> LAUNDRYTRAV i RANpEF{ppD � <br /> CLOTHES WASHER � <br /> URINAL ' WATER HEATER <br /> DRINKINO FpUNTAIN � W�D STOVE � <br /> FLOOH DRAIN ' METAL FIREPLACE(WOpD BURNING) � <br /> BACKFLOVy pqEVENTERS � F�REPLACE INSERT(WppD BURNINO) , <br /> SINK(SERVICE—BAR,ETC.) ' GAS FIREPUCE �— <br /> ' OAS RAN(3E � <br /> � � <br /> QAS PIPINO � <br /> � EXHAUSTFAN <br /> � � <br /> � <br /> SUB TOTAL S � ' <br /> PERMIT s � SUB TOTAL � � <br /> TOTAL FEE S � PERMIT a , <br /> � TOTALFEE E � <br /> FOR OFflCE USE ONLY: <br /> FIIpryT SETq�K REM SETBACK SIOE SETBACN <br /> PlANC11ELKNUAIBER FEF <br /> N RECEIPT N0 <br /> osE � ,,,�„ '��A VAC�NiSiTE rU7S� 5�Lv0 <br /> ^� FEES VALUATION FEE <br /> ti ,JU 11YE5 �j.NO <br /> !IE �y�T��pN �pp�p��U� BUILDMC � <br /> UNIiF S���BLOGRI � <br /> ' PLIIMBING � <br /> Q�MC� MD(KSIMFS OCCUPANTLO�D ' <br /> B�SEMENT — � <br /> MECH�NIGAI � <br /> ��YES fl NO � <br /> FH1E�LARM REOD � <br /> REASpry AUDIIION�I.MAN CIIEGK � <br /> i <br /> FIRE$pMNKLER REOD RE�Spn� OTNER � <br /> STRIE pUIlDM6 SIIRCMMGE i <br /> iYPE pp f,ONST PI�NS�PPROVED BY 1 <br /> I' CITY OF EVERETT ruai ir,wonKs {� <br /> JM LOCAL SALES _�_ <br /> o�re ( 'f TAl(CODE IS 3105 To7AL � ; ._ <br />