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APPLiCATIf�1 FOR CONSTRUCT'flN PERMIT <br /> CITY OF EVEFiETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITIpN ❑ COMBINATION ❑ BUILOING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADpRESS: I�I7 S,'1,,. l k k� ��,� �f ►,/a 9F2oaP <br /> �GT[��vG� ��n .t�rs n{e�c 3�G - ,F�nS�� <br /> OMHER J M1YL�Od1E55 CIfV 2iP � <br /> P��OME <br /> �AIYIG <br /> tcwwr r.n�oonEss r.nr rin —� viar�E <br /> uc�*ccT on oes�R Mut�ooness cin nr m�or�F <br /> D��� t � ?lrw�bier YO Bet 1921 Lvnrl�c��_Q�y�_�'75- �//, y DAYA/Z PN yy .M <br /> ��fR�CTpi 4N1./OOIIE55 ----7—�;iry yip rnONf � Sf�TE11C[NSE� <br /> 4E�MNALIILCONTN�CTOR MNlA0d1E55 CI1Y 7�P PIIONf S7�fELIGENSEr <br /> RUGeMq�TR/�GTOq 4uLA0p1E55 CqY IIP PNONE STATELIGENSE� <br /> CONTMCT P1110E pi Mpry{ - <br /> HEATING SYSTEM: GAS ❑ EIECTRIC ❑ <br /> � YA111(p ND50UMIEFOpTAGEkIVOIVFD CONI�GTPCRSON�II�PIIptIF.1q <br /> ���n Tc A/_sr,�_ �as �vrn a cc <br /> ' C <br /> I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> rnovos[o us6 oF euKnnq APPLICATION AND KNOW THE SAME TO BE TRI;E AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE Or <br /> WORK WILL BE COMPLIED WITH NMETHER SPECIFIED HEREIN OR <br /> �oKoeseawnouavroeaarrtsr+ovn+enoww�n�cNmecorics� NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> �oT etodc as AUTHORITY TO VIOLA7E OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REODUTIN(i CONSTRUCTION OR THE <br /> PERFORMANCE Of CONSTRUCTION.THAT 1 AM AUTMORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOA WMN�/ <br /> APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br /> ►�qca iac t.o.Mwaeq '— CONTRACTORS UW 1827 RCW AND 296200 WAC. <br /> CONSiRUCTIdI IONI LEIAER.MdiE55.TElEP11d1E MI�MEN X Q��-/�,r�/ 1/fd.OL41� �/7 Z/�� <br /> K- �� <br /> SMA�T �IC <br /> qttlV91HE55lICENSE NO <br /> ��� MECNANICAI <br /> NO• TtlPE OF FlIITIME OR ITEM FEE N0. TYPE OF EOUIPMEIIT FEE <br /> WATER CIOSET(TOILEn � NC—NFtt1pL6 UNRS � <br /> �T�T� ; FORCED AIR SVSTEMS � <br /> LAVATORV(WASH BASIN) � HEAT PUMP , <br /> ��R ' UNIT NEATERS � <br /> KITCMEN SINIC 6 DISP i CLOTHES DRYERS � <br /> 016HWASHER � RANGE F100D � <br /> UUNDRY TAAV ' WATER HEATER � <br /> CLOTNES WASHER � WOOD STOVE —;— <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKINO FOUNTAIN ; flREPLACE INSERT(WOOD BURNING) ; <br /> ��R���N � GAS FIREPLACE � <br /> BACKFLOW PHEVENTERS ; GAS RANGE � <br /> � <br /> SINK(SERHICE—BAR,ETC.) � � GAS PIPING � <br /> IXHAUST FAN <br /> � <br /> � T <br /> _ SUB TOTAL f SUB TOTAL S <br /> PERMIT S � PERMIT f <br /> TOTALFEE f � TOTALFEE f � <br /> FOR OFFICE USE ONLY: <br /> fROMT9ET9NSt REMSETMCN SIpESFTBnGK f`I�VlCIIECKNUuq�p tff 11Ff.FIPilp <br /> �� <br /> usEiowe iour�� v�c�r�rsnc FEES VALUATION FEE <br /> ❑YES ❑NO flUll(11N6 i <br /> HEIOIR IIMIT11T10N Iq pF pWEIUNb SIiE Of BIIIGrtI -- <br /> 1M175 Pl11MPMG <br /> OCCIR�NCY Iq d SI(qF5 OCLUPANfIO�D B�SEMENf I <br /> GfqIR MEf.�UNIf.�L i <br /> ❑rE5 ❑HO -------- <br /> FIflESPpINNLERqEO'D RE�SON �DDIIIONM.PUNCNfGK <br /> ___ _ - ��_ <br /> Du¢n <br /> FlBEAURMREO'D REAGpN <br /> ST�IE BUiIDINC SURCI��OGE <br /> TYPE(Nf,ONST PIANSMPROVEffBY CITVOFEVERETT �IIpI�f.WOlixS <br /> LOCAL SALES ---- -----�-- <br /> o•rE TAx COUE IS 3105 TOTAI <br />