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APPLI�w'ff!DN FOR CONSTF�1�'��:TIQN <br />PERMl�'� <br />fhe Evergrean <br />CITY OF <br />�verett 1Vefe" <br />BUILDING DEPARTM�NT � <br />259-eB10 TO €1� C0�9PLETED iN INK— PLEASE PRINT <br />f-OH9� S P�aw��i�tS <br />CVSSO FK <br />❑ NEW ❑ ADDIT�ON � <br />tENANt IMPPOVEMENT Oq INTEflIOfl qEM <br />CONiR�CTPRICEOi WONk <br />DEBCRIBE WORN.�NDSOURPEFOOfAGEI <br />1'�S�w.// 7i%/e!� S.MI <br />PHOP09EU USE OF BUILDINO <br />�/ <br />f_—��� � <br />LEWIDE P !'ONOFGROi�E TY�SHOV <br />LOT � �� B,.00K OF <br />�w✓e k� �✓�, — <br />�s��a� (.�u <br />xltci nuvncsa <br />SN/. �✓l�� <br />PLUMBINO <br />DISP. <br />LAUNDHYTpAY <br />dR ❑ DEMOLITION ❑ WOODSiOVFJFRPLII�SERT ❑ BUILOINGflELOCFTION <br />/ylt�/ lU,u, _ .Sk..7�c $ <br />PqEVENTERS <br />�C— RAINI FA <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />A�LOWABLFI�CTU�I <br />FIflE SPRINKLERS HEOUIflEO <br />o ves o e+o <br />-9i98 <br />I HEREBY CERTIFY THAT I HAVE READ AND E7(NMINED THIS APi`LICATION AND <br />KNOW THE SAME TO BE TRUE ANU CORFECT. ALL PROVISIOhB OF LAWS AND <br />OHDINANCES GOVERNING THIS TYPE OF WORK WILI BE C;IMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA F'�RMIT DOES NOT <br />PRESUME TO GIVC AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR iHE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHOAIZED BY THE OWNER OF <br />THIS PROPERN TO PEF7FORM THE WORK fOfl WHICH FPPLICATION IS MAOE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1027 pCW ANO <br />296200 WAC. <br />SIGYATUP OFCONiHRGTORORAUtHOfl2EDAGEDIi DA7E <br />X s �p1 <br />PIIGANi5C1TVBU51 ESSLIC[NSE ANODUSINESSNRME <br />MECHANICAL <br />FEE NO. TYPE OF E�UIPMENT <br />A/C— A/HNDLG UNITS— H.P. <br />FORCED AIR 5`!STEMS— B.T.U. <br />UNIT HEATERS— &T.U. M <br />CLOTHESDRYERS <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />' NOOFOWELLINQUNITS BUILDING <br />PLUMBING <br />esMr. occ �ono <br />❑ Y MECHANICAL <br />O N _ <br />MEICIITLIMILAIION OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />� PUBLIC WORKS <br />TOTAL <br />SUB <br />a <br />FEE <br />