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APPLICATI� FOR CONSTRUCT��N PERMIT � <br />�� TO BE COMPLETED IN BLACK �NK—PLEASE PRINT <br />B�ILDING�EPAHTMEN� HEATINGSVSTEM: ❑GAS ❑ELECTflIC ❑ <br />25F-881G <br />❑ L�EMOL�TION ❑ COMBINATION DC BUILDING_ ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEB , MAM1���PE55 Ci1V ��P FIqNE <br />�� ��„�or 7015 LcwerZd�c�d f.,erar"v� 9sZo3 3F5-5�16 <br />iErvnir r.uiuooness cm nv rNone <br />OESiGNEP MAILAODflE55 <br />�oi�m_ <br />[OFWOPK <br />� c� <br />RNpSIXNRE <br />B�V1 N <br />vu�ce� <br />- 200'�T �$ fi..) <br />vo <br />iow on nnnw� *wo cories� <br />� <br />FOR OFFICE USE ONLY: <br />I�iJM5ET0ICN REARSEi8AC1t <br />�' � r <br />�,����Z— �3'i.Y69 � <br />t <br />ttCE 01 CONii NO OF Si0PIE5 <br />Z <br />54EOiBlCG FIfiE5PflI11MLER5RE0O <br />� V <br />OCCIIPANCVLORD FIPEALAPMPE00 <br />PY <br />IiP <br />nv <br />SL1TE <br />day ��7- 46� - �&�, 3 355-s5�; <br />1 HEREBV CERTIFV THAT I HAVE READ AND EXAMINE� THIS <br />APPLICAI:ON PND KNOW THE SAME TO BE TRUE P.ND CORFECT. ALL <br />PROVISIONS OF LAWS ANO ORDINAN�E$ GOVERNING THIS NPE OF <br />WOPK WILL BE COMPLETED WITH W4ETNER SPECIFIE[1 HEREIN OR <br />NOT. THE GR�NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCtL THE PROVISIONS OF ANV <br />OTHEF 5 fATE Ofl LOCFL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 9Y THE <br />OWNER OF THIS PROPERTV TO PEflFOfiM THE WORK FOR WHICH <br />APPLICATION IS MNDE AND I COMPLV WITH THE STATE <br />CONiRACTOflS W 1827 flCW AND 296.200 WAC. <br />XC'� ��o�. �,�g (��- <br />�, o.� <br />UNIT <br />❑ YES � NO gUILDING <br />ryr�y�'� Fo1MPYltt�x�Wi:S <br />�;°+j rwn+ei�+c <br />�sEueHi � MECHANICAL <br />❑ VES f✓NO <br />uGlliuurtAnorv /D�ITIONALPLANCMECK <br />ZS I OTHER <br />STAfE 9UILOING SUHGHqRGE <br />CITYOFEVENETT PUBIIGWORKS <br />LOCAL SALES <br />iAX CODE IS 3105 TOTa� <br />NO <br />