Laserfiche WebLink
APPLI�ATIQ,_' FOR CONSTRUCTf �N PERMIT � <br />TO BE COMPLEi ED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ;] GAS ❑ ELECTRIC J___ _ <br />BUILDING DEPARTMENT <br />259 8810 <br />�� DEMOLITION !��. COMBINATIUN i I BUILDING I I MECHANICAL �! PLUMBING IJ SIGN <br />� _� �-. � <br />�f':>i11 MAILAOCPE55 cn♦ ar rv�c <br />n.G.�JfROf1U[SIGNFP IMttA00PE55 G'Y Z�P PNONE <br />.11<ONIPACIOF MARMDPE55 Glry 21P pNGNE SiAiELFEN$E• <br />X�i�� c�� ���P� � - <br />..�.�i!VCRCIXIiRACiOR NAILAppqE55 Clry ZIP PNOYE SUtEI�CEN56� <br />f.�.!'9u1f.CONLP�CLOR MAILAOOP[55 CITY ZIP PHq1F St�iELKENSE� <br />� JJfUGt PpqE Of KOPN <br />C['•'.RiCE�'ONN�ND �REfLOi�GEMVQVEO <br />__1 <br />9 <br />.JJ _ <br />rr.o�osm use oF ounmr�c <br />i�. �.�ocscqiarror�'o�vaovcArvisHovmeciavon• <br />io,- ewu a — <br />\ <br />�•qnGLLU%IO.NOMOER <br />'. ;I11iUClIONLONLLENOER.M�flE55.LElEPNONENL <br />PRCJECTADDNE55 <br />� S %/� �O M �x[ /'-� <br />FOR OFFICE USE ONLY: <br />�i�ONi5L1�1ACK FGRSEiBALN <br />uN:arvl WiMFA <br />11![CILpN51 NO.OFSf(1P£B <br />..:iOFOIOfi. RPESPHOMREPSPfO <br />� .�!npNCYIOAD PPEMAPMRCO9 <br />PI n�z)N <br />IIIiANCCV 1`lANSIPCNOYE�OY <br />o�rE <br />Si0E5E�8AtN <br />VACNiT511E <br />❑ YES ❑ NO <br />�MIL� MIXNNlM4UF�. <br />411N� <br />BA5E1ACN1 <br />❑ VES ❑ NO <br />HEIGIITIMIiAllpl <br />CIiY OF EVERETT <br />LOCALSALES <br />TAX COOE IS 3705 <br />LOA1.1Ct PENSON A4� Pr10NE N0. <br />I FIEflEAV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRl1E AND COFRECT ALL <br />PR�VISION$ OF LAK'S AND ORDINANCES GOVERNING THIS TVPE OF <br />WCRK WILL BE COMFIETEP WITH WHETMER SPECIFIE� HEREIN OR <br />NO'f THE GRANTING OF A PEHMIT DOES NOT PRESUME 70 GIVE <br />AUi'�IORITV TO VIOLATE OR CANCEL THE PROVIS1045 OF ANY <br />OTHER STATE Ofi LOCAL LAW REGULAiING CONSTRUCTION OR THE <br />PER°ORMqNCE OF CONSTflUCTION. THAT 1 AM �U�HORIZFO 6V THE <br />OWNEii OF THiS PROPERTV TO PEBFORM THE WORn FOF WHiCII <br />APPI.ICATION IS MADE AND I COIdPLV WITH "HE STPT� <br />CON'i RACTORS U+W 1827 RCW AND 296200 WAC. <br />�^`�'JLnCCc� /�/LL��� —_ _— <br />BUILOiNG <br />PlUMO�NG <br />MEGHANICRL <br />AOCIT'INAL PUN CHECN <br />OTHEfi <br />STATE BUII�ING SURCHRRGE <br />vueuc wor+Ks <br />TOTRI <br />M <br />