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ApPLICATI�I FOR CONSTRUC�N PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200CEDAR STREET•EYEREIT,WA9B201•25&BB10 <br />❑ DEMOUTION ❑ CO�M+BMATION O BUILDINO O MEd1ANICAL �FLUMBMI6 ❑ SION <br />PROJECT ADOi1ESS: �7 ��O Z I.3 (Ob-6% rJ � <br />_.._/�ic'/,��� /ianjlc„Y �YYzy C-'�trnw.aA ,a-N. <ec,5�[_ f��33 .�C./- °3S3 _ <br />ow.rtn u.n.muss �n rw a.v�c <br />i�Hu�� .uau�mras u�� rro no� <br />•i1LM�[C�OROFSqMR WM/.OP1F6S Gt� !il' M1Id1F <br />6ENEI14COM�n1C�p1 MNM.OI[65 GIY lm 1'�q11F FI�IEIICEMf� <br />u[[N1MC/LCd11qK�OR M�0.�Dp1F55 fAIY 1il' Plph i1�fElICENS[� <br />O[YPoeF MO�K �MO SOv�nE r001/DF �1v0.vEo' <br />(_tiJ .S�/�Ort /C.� <br />rraroscouse a euaaxo <br />lfGUIXxmmiqx Of Pnq'FPn IS�qwH RtOwOn �n�Cr� <br />iot eiocK a <br />.3 93 9- anG - oi 3— D/ <br />r.nccirw�in.Mn.wEn <br />mrsmuctpu iaw itr1o[n, wonrss, rcicnq� riwe[n <br />DRINKING FOUNTAIN <br />� PERMIT f <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />fIqNIS(IB�C� KMSEfBKM S�CE6(iB.�M <br />USElWF 101e�f� v�GWI511E <br />OYES ❑ NO <br />��[T.II�Uµ�AIpN MOOipWCIIMO Sl`FWBLOO�II <br />UNIIF <br />❑YES OM�1 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />cor.i.n rtasw u� rwrrt w <br />I IIEAEOY CEflTIFY THAT I NAVE READ �NO E%AMINED THIS <br />APGLICAiION AND NNOW THE S�ME TO 0E TRUE ANO CORRECT �LL <br />PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE Oi <br />WORN WIIL CE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />NOi. THE GRANTING OF � PERMIT OOES NOT PRESUME TO GIVE <br />AUTNORITY TO VIOL�TE OR CIINCEL TME PROVIfiION OF ANV <br />OTHER STATE Ofl LOCK UW REGUUTIN6 CONSTRUCTION OR THE <br />PERFORM�NCE OF CONSTRUCTION. THAT 1 AM �UTIqHIZEU 8Y TME <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNILH <br />APPLICATION IS MADE �ND I COMPLY WITN TNE ST�TE <br />CONTR�CTORS LAW iB27 RCW �ND 796R00 WAC. <br />x i n PZi L.���iz iz-S'- 9� <br />sarurur� wrc <br />CItYlYQNESS IC[t/H 1q <br />1•��.�LE'57��� <br />GAS MNGE <br />FAN <br />, �u� n¢x mwnm <br />FEES <br />IlUttllnl(1 <br />1'11q�pYlp <br />urn�w¢u <br />AppIIlN11l R/�N C�?CN <br />OI�K� <br />s.rt ommMr. s�ntwM:c <br />CITYOFEVERETT rvniMwm+r. <br />LOCALSALES <br />TAX CODE IS 7105 7oTAL <br />i <br />