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KPPLICATION FOk% [61 <br />CITEL.ror"" CONSTRUCTION <br />CITY Or <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259-8746 ❑ <br />COMBINATION ® BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />UN TIER <br />Boyden Realty, Inc. <br />MAIL AnUnr SS <br />1429 Broadway <br />City <br />Everett <br />21r <br />98201 <br />r"ONE <br />252-1166 <br />Anc,rfrct On nE91nNFR <br />Gary Parkinson <br />MAIL ADnRESB <br />527 Medical Dental <br />city <br />Bldg. Everett <br />98201 <br />9 <br />rI1RNC <br />252-2153 <br />ZIP <br />PIIONE LICENSE <br />1166 223-01 <br />UENEnAL CONTRACTOR <br />MAIL ADDIUBS <br />MAIL ADDRESS <br />Clly <br />IF <br />ru NE <br />JDBUI223JO IICENSEA <br />M[CHANICAL CONTRACTOR <br />PIUMRPIO CONTRACTOR MAIL AUUFf 3. �"' <br />White Coast Plumbing 119 Avenue A Snohomish 98290 568-6155 <br />CLASSNEWa ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEnT ❑ BUILDING RELOCATION <br />VALUATION OF WOnK ICOBI OF MAItn1ALS PLUS LASOM <br />DESCRIBE WORK <br />_ 1 _I _.._.. OR w <br />new o...W...: ........A .._..___..__ __-. A <br />USE OF BmtDlrro <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />SFR <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OESCNIPIION Or PROPEFINIRIIOWN n[LOW On.ATIAC" FOU"Co""SI <br />LEGAL <br />Sunridge Div. III <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />10 VIOLATE OR CANCEL THE PROVISIONS Or <br />GIVE AUTHORITY <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PER`F�ORMANCE OF CO STRUCTION. <br />SIGNATURE Or CbNI`RA TOR OR All OR ED AOEIIT DATE <br />X Q <br />112 - <br />•/ <br />PROJECT AOOOEB9 <br />APPLICA re CITY BUSINESS LICENSE NO <br />! J <br />PLUMBING <br />FEE <br />_MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPG OF FIXTURE <br />Ain <br />_ <br />WATERCLOSETITOILE <br />REFHIOERAfION UNITE-H.P. EA <br />nErRIG RATIO UNIT H <br />_ <br />_BATHTUB <br />BOILERS-H.P. EA <br />LAVATORY IWASH BAST <br />OAS FIRED AC. UNIT S-TONNA(IE EA <br />8140WEFI <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />KITCHEN SINK B DIBP. <br />WALL HEATERS-B.T.U. M <br />DISHWASHER <br />UNIT HEATERS-B.LU. M <br />LAUNDRY TRAY <br />- <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />_ <br />WAIEBHEAIER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />HANDLING UNIT- C.F.M. <br />_ <br />FLOOn DRAIN <br />_Ain <br />VACUUM BREAKERB <br />_ <br />_ <br />STOVE <br />METAL FIREPLACE B CHIMNEY <br />-- <br />_ <br />nOOF 011IINS-RAINLEADER9 <br />W000STOVE/FInEPLACE INSERT <br />_ <br />SINK SERVICE -BAR ETC.) <br />BUB TOTAL <br />_SUBTOTAL IT <br />PERMIT S <br />_TOTAL FEE i <br />PERMIT <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SIOE <br />USE ZONE - Lot ABTA I VACANT RITE I <br />OYES LINE) <br />LOAD <br />RI/ /b/ Ei <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />O111ER <br />PENALTY <br />TOTAL <br />PLAII CHECK FEE <br />FEE -L45— I RECEIPT NO. <br />E <br />