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APPLICa►TI�N FOR CONSTRUC�OI�f PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVEPETT, WA 98201 • 257•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />.,....... -� ------ <br />n/ �c Y> G S 2 b' /-veirs,u.in nuA- f' Gs�c2�•` 4 z r 7'f.S =�f �� <br />rewvrt uu��oon¢ss cm zir ��a� <br />Ofl0E5IGNEli Mn�IWu�R:�a �• .� <br />=NcY Ccmci? /os�l �9�'1 .t.� rff su/7t <br />fi.� r�r ����-- ., <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />. I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAh1E TO BE TRUE AND CORRECT. ALL <br />PflOPoSEO USE OF BWLO11q pqOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILI BE COMPLIED WITH WHE1HEii SPECIFIED HEflEIN OR <br />LEG0.DESCPIPTqNOGPROPEAII'15110WNDELOWOPI.TLLIIT\YOLOPIESI NOL TF1E GRANiING OF A PERMIT DOES NOT PRESUME TO GIVE <br />mr o�oca Or AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OP ANY <br />OTMER STATE OR LOCAL LAW REGULATING GONSTRUGTION OR THE <br />PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM TME WORK FOR WFiICH <br />APPLICATION IS MA�E AN� I COMPLY WITH THE STATE <br />au+cc�n,x io uuuoce CONTRACTOR/SJ LAW t827 R ND 296200 WAC. <br />CON:iPUCTqNLO�NLENOFR,IDORE.S.1ElE���WIEINWEII x �,(U.� /�zZ-�"�� <br />SNIIUNIIE DATE <br />GITY OUSWE55 LiCENSE hV <br />OH ITEM <br />HOO� <br />SINK ISERVICE — BAR, ETC.) I � I I GAS <br />FEE <br />FOR OFFICE USE ONLY: <br />iR01lt5Ei04K AEMSEiO�CN SIpE5Ei0/�Clt PL.VICHECI(NVYOEP � FEE RECEIPT <br />VSCIONE IOi�PE� V.�C/.NTSITE �Co <br />❑YES ❑ NO OURDING <br />nE�G�R1141lA11011 fq' SLpµEllltq SIZEOFOI.00✓fl <br />ttuuo�Hc <br />OCCUa�NLY M[�Si0N15 OCCIIPINilD�O 0/.SEUExi YEM�V1iLLL <br />GPOU� <br />❑xE5 ❑NO <br />FWESP��t'RIENREOD PE/�SON '��Tb�P���E� <br />Oi11ER <br />�WE�W1u�E0�0 PE�SON <br />STALE 6U�tDllq SU11CN/ALE <br />rrvEo�co.�sT rw�s�nvnoroer CfTYOFEVEflEI'T wo�Gr'aucs <br />LOCALSALES <br />.,..� TAX CODE IS 3105 TOTAL <br />FEE <br />