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APPILICATI�1 FOR CONSTRUC'�ON PERMIT� <br />CITV OF EVERETT • BUILDItvG UIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS <br />OWNCR uuuu¢ .•�• _- ...___ <br />.1obnT LoN:� (,j/O �on.ba�c✓9�e F�/�oiY �1��3 ya5-Si3-69JG <br />}(ryµ{ 4AIL��V1ESi CILY L�P N1TR <br />nR�HiiCCtIX+M5Gt1ffl M/.M1�OIX�L55 CITY ZM f1Kl�Z <br />pp��qµ�p��q,�{pq YAR�ppRE55 CIfY ZIP PMIXE 6iRELqFNSE• <br />4LCn�NCALMI<iPl�Lip1 M1M1M011a55 CiiY !W F��Gff St1iEL�CLNSE• <br />E r� .v >.u„ rn�.r4 � i���= •ry•,,�• �rv v. E„�,.r� aF�� �so-a..v �(�EN6SSOD7oT <br />f'WNB CON(PALIOfl NNL.Nq1k55 GItY IIF VMO�R S1AiELFfNSE• <br />CESCr+IOE wW�K YN SW ME <br />LOi BLOCN <br />FOR OFFICE USE ONLY: <br />IPONCSElO�CA RE�RSEiBACN <br />USEIONL LOIME� <br />n[iw�rtiurt�rqrv Ho�ow[urt+a <br />I ❑YES []NO <br />sizcar azm�i <br />!]YEC [] NO <br />CITY OF <br />LOCAL <br />TAX COC <br />HEATING SYSTEM: _�(".+AS ❑ ELECTflIC ❑ <br />c.�»rt.rr v[asov i,xa rrrori[ M <br />y <br />I HEREBY CERTIFV THAT I HFVE READ AN� FZAldWCO TNIS <br />APPLICATION AND NNOY! TME SAME i0 BE TROE AND CORRF.Ci ALl <br />PROVISIONS OF LAWS AND OPOINANCES GOVEPNING THIS TYPE OF <br />WORK VlILL BE GOMPLIEU WITH WHETHER SPECIFIED NEFEIN OR <br />NOT. TNE GRANTING OF A PERIAIT DOES �:OT PRESVME TO CIVE <br />AUTHCHIiY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHEH STATE OF IOCAL L.AW PEGULATING CONSTRUCTION OF THE <br />P[RFORMANCE OP CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEH OF TMIS PROPEFTY TO PERFORM THE WORK FOfl WMICH <br />APPLICATION IS MADE ^ND I COMPLY WITM THE STATE <br />CONTRACTORS LAW 1B2] RC.V AND 29G 200 WAC. <br />SiUUN�E DetE <br />CIiV B119N65 LiLE16E NO. <br />euna�+a <br />ttuuewa <br />Y[GN�NiLAL <br />IJDITKK,KPLANC„fCK <br />on�En <br />SlA¢ BWLdNG SURCN�RGE <br />RIOLC WOPKS <br />TOTAL <br />PCCEII'i W <br />