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APPLICATIQ'°"9 FOR CONSTRUCT..�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />, 3200 CEDAR STREET • EVERETT; WA gg201 • 259-BB10 <br />❑ DEMOUTION ❑ COMBINATION ❑ BUILDING ;�MECHANICAL �PLUMBING O SION <br />PROJECT ADDRESS: � J�� , ��I C' �p y. o � C-- <br />OMNER MNLII0IXIE55 CIIY 71P PIqNE <br />��� rJ- ��, IK �E 5; �cti w�r, r��<<Au �.�!!t 9,.�i icr-� ,;2 3� 37 7 0 <br />�� Z��L�u� / P110NE — <br />c! .�,�. �,L� .�f9 I � 9..5� <br />�nc�n*cc� on oes�e Mu1 ADORE55 citt m� r�aHe � ' --- <br />GENEMlGq1TMCiOq MuIMOqE55 CIfY )If PiIONE SIATEUCFNSE• <br />MAII AOIXIESS <br />,. � I <br />CpITRAGT:�MCE pf� Wp��Ny`, <br />% ��Q� �� <br />OESCRIOc Nq11N�NU SW�R� F(pT�GE INVOLVEO <br />L•:� <br />IECuLL OE$CipPTIOk Oi P{1pPERTV <br />LOT _ �p�K _ <br />CON57RUCTION IOAN lENOEP, �pppE55, TElEP110NE NUMBEp <br />�• I TYPE OF FlIfTURE OR <br />� WATER CLOSETITOILETI <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FLOOR DRAIN <br />BACKFLOW PF <br />SUB TOTAL S <br />PERMIT S <br />TOTAIFEE f <br />FOR OFFICE USE ONLY: <br />FNONT SE7B�LN REM SETPA�K <br />USEIONE IOT�REA <br />HEIONTIIApTATION lppFpWE���NG <br />VNI7G <br />OCCUPANCY W Of 51•NIES OGCUPANI Lp�D <br />PEO'b <br />REO'D <br />CITY lIP <br />���I��l[GlI-J-WI<��2i)� � <br />nn <br />/' / r � <br />HEATING SYSTEM: <br />if iIACTPCfi5p1�NOPppryE <br />l� n c n i. 1: ...,1 <br />PNONE <br />� in'�Y' wl �.�DS l�G:� 3 7.t y- <br />PIIONE ST�TE LICENSE � <br />/� !� <br />�GAS ❑ ELECTRIC ❑ <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KYOW THE SAME TO 8E TRUE AND CORRECT ALL <br />p PROVISIONS OF LAWS AND ORDINANCES GOVERN�NG THIS TYPE OF <br />WORK Wlll BE COMPLIED WITH WHETHER SPECIfIED HEREIN OR <br />NOT. THE ORANTINO OF A pERM1T DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOqIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORN FOR YIHICH <br />APPLICATION IS MAD AND I COMPLY WITH THE STAT@ <br />C TO A AND 296200 WqC. <br />X � � . ��"�- 5'(0 <br />� _� ��� _ . DATE <br />SIDE SFTBACN <br />VACANT SITE <br />❑YES ❑ NO <br />CITV BUSVlESS IICENS[ NO. <br />IECHANICAI <br />NO. TypE pF <br />_ NC — NHNIX.p UI <br />FOqCED AIR SYST <br />HEATPUMP <br />RANGE <br />FEE <br />_ SUB TOTAI S „j[� ; C7, <br />PERMIT S � <br />� TOTAL FEE S '�o n <br />PUNCIIECNNUMflPfi fEF I7Ef.FIPTNp <br />�! 7 Qc� <br />�UII OINC <br />SIZE OF BIDC✓fl <br />{`LIIAIOING <br />BASEMENi MFC11nNlf.�1 <br />❑YE$ ❑ NO --- <br />�onnwr�ei. ri eN cnr cK <br />on�rn <br />51�1[ ppll pING 51IfIC11Ali0E <br />CITY OF EVERETT rum ¢ wonKs <br />LOCAL SALES — <br />TAX CODE IS 3105 toTAt. <br />