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-' APPLICATIC`y FOR CONSTRUCT'""•)N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� <br />2 <br />i <br />uFa7wG SYSTEM: �l GAS ❑ ELECTRIC �.l <br />BUILDING DEPARTMENT <br />259-8810 <br />[ 1 DEMOLITION ! I COMBINATION <br />OWpNER MAILAODRE55 <br />1 }2'41.��z .7'tS1C_.-n.J 1 i? �i0:� F�ll <br />MAIL <br />CR <br />BUILDING ��1GECHANICAL �-'PLUMBING <br />��T. Z�p PMONE <br />IJhY �9 .sJtT6 1-l. I.YNt-� �c D �JI� °i�� <br />ZIP <br />��TM Z�p PHONE <br />��n, Z�p vNONE STntE LICENSE / <br />GENEfiALCDNTRAGTOR AIRiLPDDRES$ <br />��T� Z�p PNONF SiPtE IICENSE • <br />A�FLHANICAlCO,1111AGi0R MAILAODRE55 <br />��n, Z�p CHONE SIDTE UGENSE • <br />P�UN.OINGCOHTRRCTOR MAILAODRESS <br />CONiR�CT PNiCE OF WOFK <br />OESGRiDE WORN PNO SOWRE FOOT�GE INVOlVEO <br />ewiou+c <br />CONTACT PERSON ANO FMONE NO <br />LEGAL OESCRiPtiON OF PROPERTY ISNOWN OEIOW Ofl ATTALI� TNK1 COPIE51 <br />lOi— OIOCN OF <br />PARGCLIR%10 NU�OER <br />CONSI�UGTION tOaN LENDF.R. R�L8E55, <br />� <br />� <br />8 <br />FOR OFFICE USE ONLY: <br />FRONTSET9ACK RE�RSF.T84CK <br />❑SEZONE IOTARE� <br />iVP'.Of fOV51. r10 OF STOFiES <br />SRFOtBLOG FIqESPRINKlEASPEOD <br />pCG11i,NCV IOAD FIRE PIARM R[OD <br />PF�SON <br />BV � PLANSAPPROVE� <br />ORTE <br />5 <br />❑ VES i-1 NO <br />awnexcr xoaow�uir.�u¢ <br />c5ouo <br />i�:� VES :-'� NO <br />CITY OF EVERETT <br />LDCALSALES <br />TAX COOE IS 3105 <br />� ' SIGN <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BC TqUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHOFIZED BV THE <br />OWNEfi OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />,,CONT[�\ACTORS LAW 18 27 RCW AND 296,200 WAC. <br />.: Y—,.� V/� /L `C��,�.,� � <br />� : <br />IilIJ <br />T.U. <br />VENTILATION FAN <br />RANGEHOO� <br />HEAT PUMN <br />GAS PIPING <br />EXHAUST F� <br />BUILDING <br />PWMBING <br />MECHANICAL <br />ADDITIONAL PLAN CNECK <br />OTNER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORNS <br />TOTAL <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />NECEIPT NO <br />�p <br />tl <br />