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N�15/ <br />APPLICATIQ 1 FOR CONSTRUCTi )N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �+T�` <br />BUILDING DEPARTG1ENT �HEAiING SVSTEM: �AS J ELECTRIC J___ — � <br />259 8010 <br />OEMOLITION � COMBINATION . '� BUILDING � ECHANICAL �. �. PLUMBING �. ��. SIGN <br />�� I IIALADOPESS ^ �Ii�, IP GUGHC <br />��'��d.��7JLr�y�l�'� 3ss-��z,�r, <br />lt��qili NRiLAO�fl[-5 GR LIV PNONE <br />nuO�rtECi060k5i4tl[H M�IL�DpRL55 CIIV ZIP PNONE <br />t.lA[tUtf,O�ltH>LIOR UALAODPE55 CItY ZI> PIIONE Sl�iEIICENSE• <br />`��It:l!'nNICALCOI1iMLOfl .UI.�LAUORE55 CRY IIV PNONE $iAiELICENSE• <br />�YS � _ . /�/" �r:/� <br />LDNii1�G�i�PyIIiC'EJOi <br />'!(/� <br />�CSCII�}'. W011N RNO <br />fitC�'OSFO OSE OF 11 W:OiNG <br />l(pM DESCPIPTqI Of PqOPEPrv RNOWN BELOY <br />ior o�ocK oF <br />rencu *e.io uuueen <br />�,;:;Lui��ipry�ppylFNpER AOOfiE59.ffLEPNqIENVMBEl1 <br />oaniNs—anu��enoeas <br />FOR OFFICE USE ONLY: <br />inc•n�[ronce nenasEn <br />us[ LONE LOtAflEA <br />a or cor+sr Ho oc s*i <br />'�,:f.Of11LIXi iIBESPPM <br />tcLiIFANCYlWO iINEAL.�PA <br />��I nSpY <br />er rurvserveweoer <br />onie <br />� <br />CONiACI l'Efi50N AtlD PHGNE NO <br />I HLREBV CERTIFV THAT I HAVE READ AN� EXAIAME� iH15 <br />AP.^:1�^110N AN� KNOW TME SAME TO BE TRUE ANO COFRECT ALL <br />PROVISIOP.S OF LAWS AND ORDINANCES GOVERNINCa iH151VPE OF <br />WORH W��L BE COMPLETED WITH WHETHER SfECIFlED MEREIN ON <br />NOT. TFIE GRANTING OF A PEflMit DOES NOT PRESIIldE TO GIVE <br />AUTMOPITV i0 VIOLAiE CR CP.YCEL THE PROVISIONS OF ANV <br />OTHEF S�ATE OF LOCAL LAW FEGU�ATING CONSiRUCTIOt: OR THE <br />PE^POR�IAM10E OF CONSTROGTION. THAT I AM AUTHORIZED BV TME <br />OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOP WHICH <br />APPLICATION IS MAOE AND i COIdPLV WITH THE STATE <br />CONTRACTORS LAW 18.2� RCW AND 29G200 W�C. <br />��laa�� 9/z� 3 <br />�...r.� i.��r -'1 <br />soeseie+cx vurvc„ecxxwieen I <br />ve<u�*5rtE FEES <br />C7 VES i' NO BmLowa <br />uia�u�. me»!io-w�:s — <br />PLUM�MG <br />aeSEueHi MECHANiCAL <br />r-' yES '. : NO <br />nEi.NTLnartniiO�v ADDITIONALPLANCHECK <br />OiHER <br />STATE BIIILDING SIIRCHRRGE <br />CITY OF EVERETT ruoi ic woeKs <br />LOCALSALES <br />TAX C�UEIS 3105 TOTA� <br />