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A�PLICATIO.J FOR CONSTRUCT�JN PERMIT <br />CITY OF EVEREIT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />O DEMOLITION ❑ COMIBINATION O BUIIDING � MECHANICAL ❑ PLUMBING ❑ SION <br />MNL <br />•RCMTECTq10E51CNER WIt/�DDRE55 CIIY IIP PMONE <br />11P pIIONE SUTE LICENSE � <br />YECNANiCAICONTRACTOR MNLADDNE55 ('ATV ZIP PIIONE STATELILENSE/ <br />PIUIlNGCONTRACTOR 4AILAOORE55 CIIY ZiP P110NE StATEL10ENSE� <br />PIiLE OF <br />LOT lLOp( pF <br />4,3a1�- 3��- 615- 000� <br />PAqCEL Tl1% LD. MltllER <br />CONS7IMIC710N IOAN lENOER. AOOqE$5. TELERIONE NIIIIlER <br />��� <br />NO. TVPE OF FlXTURE OR ITEM <br />WATER CLOSET (TOILEn <br />�� <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />dSHWASHEH <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKIN6 FOUNTAIN <br />ROOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.) <br />SU8 TOTAL S <br />PERMIT S <br />TOTAIFEE S <br />FOR OFFICE USE ONLY: <br />iNONT5ET8�CK REMSET&1CK <br />USE ZONE <br />NEIGHi LIAIITATION <br />OCCUP�NCY Iq of StptlES <br />GNOUP <br />l0T 11pE� <br />ra oF owewnc <br />UNIfS <br />O�TE <br />SIDE SETB/iCK <br />� OYES ❑ NO <br />si� oF e�ocru <br />❑YES ❑ NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: �I GAS � ELECTRIC ❑ <br />CONTACT PERSON �qp PHONE NO � � _ �, <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE CAMPLIED WITH NMETHER SPECIFIED HEREIN OR <br />NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GI`/E <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />ONMEH OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA ORS LAW 1827 CW AND 296200 WAC. <br />x 3-� � - `l� <br />� D�TE <br />diV BU9NE55 L10EN5[ NO. <br />� <br />NIi�NR1YULN VIYIIJ <br />FORCED AIR SYSTEMS <br />UNIT HEATERS <br />CLOTHES DRYERS <br />MEfAL FIREPLACE <br />GAS FIREPLACE <br />GAS RANGE <br />SUB TOTAL S <br />PERMIT f <br />PLIINCIIECNNU4B�R I FEF � AFCEIPT <br />BIIIl01NG <br />PUlM61NG <br />MECN�NIC�I <br />�DDIfION�L PIAN CH[LN <br />OTHEP <br />STATE BUIIDMG SI/RLH�f10E <br />ruai ir, woaKs <br />TOTAL <br />