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� pppLICr3TIC"1 FOR CONSTi�UCT" 1N PERIIRIT (;� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �J7^ <br />I I ATING SYSTEM J GAS �l,ELECTRIC J � <br />BUILDING DEPARTMENT <br />259-8810 f l SIGN <br />� DEMOLITION I 1 COMBINATION BUILDING I i MECHANICAL I, PLUMBING <br />21P �ONE n ��� � /) <br />' �C�TV r��/ -Lon 1 � <br />0\YNCR MNL��ORHSS � � � <br />� /�/) � � / %�)% Y1( � <br />ZIF' PMOI�E /. '/ (�' <br />TENF T M�ILAODflESS �) f n ��/I �y-t �'3 (20G) yr �3 �U y 6 tS <br />+�.a �«Y.�� II l�o! s 9 Z� Q„1. NF rl�n l� f' a r <br />I�� YY LI7Y 21P FMONE <br />pq�NIT,EGTO DESIGNER MAILADDRESS <br />j�� I PypNc STATELICENSEb <br />� r ��T� ��P <br />� <br />—__ <br />CONTFACT PRIGE OF WORN <br />UESCRIBE WOAK AND SOUPRE FOOTAGE INVOLVED <br />—'J <br />. <br />PP.�OSED USE OF BUIqDING <br />yiv� i�h�ln E` Qr�55"!� <br />I.EGAL DESCPIPTION OF PPOPERN ISHONN BF.IOW OR AP4CH TW GOPIES) <br />LOT <br />BLOLK OF � <br />� <br />CIT P PHONE <br />;pNTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANG ORDINANCES GOVERNING THIS TYPE OF <br />NOT THE GRA T�ING OF AD ERMITJDOES NOT RIESUME TO GNE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STFlTE OR LOCAL LAW REGULATING CONS7RUCTION OR THE <br />PERFORA7ANCE OF CONST9UCTION. THAT I AM AUTHORRED BY THE <br />pWNER OF THIS PROPER"Y TO PEFFORM THE N'ORK FOR WHICH <br />APPLICATION IS MAGE AIJD I COMPLY WITH THE STATE <br />CONTRACTOFS LAW 1027 RCW AtJD 296.2G0 WAC. <br />FQR OFFICE USE ONLY: sioeseTencK PLANCME KNUI BER <br />FFONT SETB�CK PEAR SETBACK <br />VPCANT SITE FEES <br />USEZ^E� LOTAREA <br />[� YES �-� N� BUILDING <br />- � NJ.OFSTORIES OLCUPLNCv �+OO�OVYFIU�IGu4ii5 <br />rvaEorCatlSi ��� PLUMBING <br />� FIPESPRINKLERSREO'� BASEMENT �� MECHANICAL <br />s¢e oF eioc. ^ YES / N� <br />C � �VD MEIGH7LRAITA7ION ADDITIONALPLANCHcCK <br />JGCUP4NCYlOAO FIREFLAFMREO'D <br />N D OTHER <br />� � _—�—�-- <br />REnsJN S7ATE BUILDING SUFCHARGE <br />ILTAHL6V PLANSAPPROVEOBV CIiYOFEVERETT PUBLIGWORKS <br />� LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />onre l�(���G.7 �. <br />FEE REctiri nv. <br />�T. %J ����) <br />