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APPLICATrN FOR C�ONSTRU�ON PEFtMIT�}�. <br />CIN OF EVEFETf • BUILDING DIVISION � <br />3200 CE�AR STREET • E�'ERETT, WA 98201 • 257�8810 ��'r <br />i <br />Q <br />❑ DEMOLIlION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ S�GN <br />PROJECT ADDRESS �� a L b w E� ��`r£ �� <br />OWNEP MAIIMIXVE55 LItY Ip p�bNE <br />Fk.15ro.J f�s�J.I� �-�-� L��4 144r tl-..lE v-�.ry:��c.�� c.�4 `%e=1-r �4z�5AB-!'19i <br />TEWW� MNL�OOPE55 GIY SI' PIpNE <br />MCHrtECT0i10E51GNER MARAW11Ei5 G1Y ZIP PHONE <br />F*•w.f cs�l� Des�� � E,.cfE-rr wk- <br />GENERAICONiMCTOP MMLAOME55 tltt �iP PIIONE Si�TEl10EN5E• <br />�yL S kr-E <br />F�w.rsnoz:�� <br />ST�iE IICENSE � <br />7� 2 E F+ R�.G '�"-4M1'1 t v � t-LF_ �..) +t— <br />hUM01NpCOMMLTOP MNLAD�11E53 CITT I j�% PNONE STAtEt10EN5E� <br />"'�-h-P^�s✓i�c..6 P�1.. N..e�.t� <br />CONiPACi Pq E OF WOPN <br />a'S-,��^ HEATING SYSTEM: C9'�AS ❑ ELECTRIC ❑ <br />[1ESCRIBEWdIXNlOSOUMEi00iMEYN0.VE� COM�j TPEIISOII� PNdaN'J. \ <br />�ris� �$F' S�� FINao rM�STDw� �{IS)$Z7Q��}I�f(e <br />2 i on s+�-s 1�— <br />�or _Z oiocK <br />FLOOR <br />FOR OFFICE USE ONLY: <br />fi10M5ET9/�L✓� FEAflSEiO�N� � <br />3 � <br />IISEIDNE � LOT�f1[A ��� <br />1� ) <br />NEIGIRUYIiAiION� NO.OFDWELLW(1 <br />1 C UNIiS <br />I HEREBY CERTIFV THAT i HAVE READ pND EXAMWED THIS <br />APPLICATION AND KNOW THE SAME TO BE THUE AND CORRECT. ALL <br />PpOVI510NS OF L4WS AND OHOINANCES GOVERNING THIS NPE OP <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIE� HEREIN OR <br />NOT. THE Gi1RNTING OF A PERMIT OOES NOi PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CNNCEL THE PROVISiON OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OH THE <br />PEPFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE VIORK FOR WHICH <br />APPLICATION IS MAUE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 29fi200 WAC. <br />X <br />SIGNANIIE DAtE <br />CIiY BUS:NE55 LILENSE N0. <br />5 � <br />S � <br />S <br />OESEIBKr•N � {y�NCHF <br />, C <br />�CNIT611E <br />YES O NO BUlOW6 <br />orEs � <br />CITY OF EVERETT <br />LOCALSALES <br />TA7( COUE IS 3105 <br />RUMBiNO <br />A1[LNAMC.1l <br />IDDIiroWLLPW1tnECN <br />OIIIEA <br />Si�IE 6UM1OiNG SUPLHUIGE <br />we�cxroaKs <br />TOTAL <br />FEE IAECEroTNO <br />