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everett <br />APPLICATIO 'FOR CONSTRUCTC N PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the Eva.19reen <br />CITY OF <br />everett HEATING SYSTEM GAS ❑ELECTRIC <br />BUILDING DEPARTMENT <br />25S-8810 <br />I7 DEMOLITION L I COMBINATION I I BUILDING 211 MECHANICAL <br />PHONE PLUMBING <br />CITY <br />// MAIL ADDHtSa <br />7T LG.N/G •3901 /%)T <br />DESIGNER MAIL ADDRESS <br />MAIL <br />CITY ZIP <br />4vo) 77' <br />CITY ZIP <br />re ,e ee t t�17 <br />CITY ZIP <br />PHONE <br />iE ' IeeNoe A <br />is�6 GY.M/P <br />oc LICENSES <br />I I SIGN <br />/ KL� CITY J G ZIP c» <br /># NYG CONTRACTOR ESS MAIL ADDRel,.r IvCAr/A/O T\O GV 9,2aoq 3•�_ eR,u�'r /�7L� <br />CLASS OF WORN <br />7 NEW f_l ADDITION X ALTERATION I REPAIR I I DEMOLITION I. I WOODSTOVE FRPL INSERT ! _i BUILDING RELOCATION <br />CONTACT PERSON AND 'PH/ONE NO. <br />LOT BLOCK _ OF <br />PROJECT ADD <br />390 i <br />DRAIN <br />OR <br />DISP <br />FOR OFFICE USE ONLY: <br />USEZONE LOT <br />TYPEOF DONTS. ALLOWABLE TYPI <br />NO.4 <br />FIRE <br />0[NI'.WCY I NO <br />GN All, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR j <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVF. <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LOCALOTHER STATE OR <br />PERFORMANCES OFCONSTRUCTION. THATG CONSTRUCTION <br />AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNAIURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />F�� <br />c�AND BUSINESS NAIAE <br />BUILDING <br />PLUMBING <br />OF <br />AIR <br />CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY O EEVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />0 <br />