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APPLICATIeN FOR CONSTRUC'� DN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING D�MECHANICAL �PLUMBING ❑ SIGN <br />OWNEII MAll�0�qE55 CILV ZiP PNONE <br />Tv � d1 os �F u;ea�L_ � iu, F�rcrr <br />IENAHi MAR DOR[$$ � QIY ZIP PIIONE <br />�YA�$ut/ls rnh'fC <br />♦PCNIIECION�ESiGNEP ANRADLOE55 COY ZiP FHON[ <br />GEN[MICIXiTMCiOF IA�ILA��OESS CIiV Z�P P�KK1E SiAiEIILENSE� <br />�/! i� Cati�aT� f Co f o� r�J./ c wir � <br />1AELNANILPILONiNACiOR MAILADOPE55 CIiY ZIP FNONE SLAiELILENS/E�I <br />��@�LCCV (OK�� �/RJ/T��D�Ii�� <br />RMG10B MhLLA0�11E55 CRY ZiP P1qNE SiTiE4CENSE� <br />WOBNAlID50UAf1E <br />GONiACi F[PSON ANO PIIONE NO <br />i HEHEBY CERTIFV THAT I HAVE REAO AND EXFMINED THIS <br />PqOPJSEDUS[OF OWLOiNG APP�ICATION ANO KNOW THE SAME TO BE TRUE AND COPRECL ALL <br />Co �GF'' G- PROVISIONS OF LPWS ANO ORDINANCES GOVEFNING THIS TVPE OF <br />�ecn�oe,cairnouor vnooen*r�s� fiELOW ORATiACN1NNCOPIES� WORK WILL 9E COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br />NOi. THE GPAIJTING OF A PERh71T DOES NOT PHESUME TO GIVE <br />�or eiocK or AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEP STATE OR LOCAL LAW flEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNEit OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />qPPLICATION IS t.1ADE AND I COMPLV WITH THE STATE <br />vnnce� rnK i o. rvuuecn CONTRA/CT)ORS LAW 1827 RCW ANO 296200 WAC. <br />CONSIPULTICNWANIENDLP,R�DflESSJELEPN011E11UMOEP x //� p f , C <br />)�� / '/ / / 1]� S /i- /3 <br />7=�-r t� •�-� <br />PHOJECT AOUNE55 sK ww� one <br />SUBTOTAL 5 <br />FOR OFFICE USE ONLY: <br />FflONiSEiB�LK PEAP: <br />R�NGE <br />FAN <br />lISEZMIE LOTAPG VALANTSIiE YtCS <br />11 YES ❑ NO BUILOING <br />LYG[�(CONS�. ���FSiOPoES OC[un�y[� �p{CMLLiN4L\:li <br />°P°" PLNABING <br />5¢EWOIDG. fIPESPNNNL[PSP[OD BASEMENL MEGHANICRL <br />❑ ves � uo <br />OLGUcu¢vl0<0 iwenuPunEOD tlE!G�rtuFu1R1�ON ADOITIONALPLANCNECH <br />P[ASON <br />OTH[fl <br />SiqTE BUILOING SIIFGHARGE <br />nrteneor vwrvsnNruoveunr GITYOFEVEHETT PUOLiCW0�K5 <br />;J�'j LOCALSALES <br />nn*i �,/ ��A� TA% COOE IS 3105 TOTAL <br />fEE <br />M <br />