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APPLICATI�1 FOR CONSTRUC'�N PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 257•BB10 <br />❑ DEMOLRION Cl COMBINATION y� BUILDINO ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />�i <br />PROJECT ADDRESS � �.�r /n /I // r._ �.. I I <br />a:S�3 <br />ARCN1IECLIXiCGSIUNfR Y4l�DME55 CITY l�� RpNC <br />O[NCML[ONIN1ClOR Y�M1I.�0.1[55 C�h Sro R�GIE 51�¢lqENSC• <br />1A[CN�NIC4CCNIP�CIDN M�II�DOPC55 CIiV ZIP %IOIIE Si�1ClICENSE• <br />RU48�NGCONiN1CiOR Y�II���N[5$ CIiY I�P A101i[ 5111fLKl115f• <br />WORh <br />'�inr � e�ecK �1 <br />6�ack SSI v-nl -toh <br />oG !oF N rr�l�k,l h <br />OF <br />FOR OFFICE USE ONLY: <br />rno•.tscio.c.: / Innas <br />��Na�m <br />. <br />� <br />TOTAIFEE S I <br />SI�iC $[iB/.LS <br />a�[:ov� � I�o�n��e. <br />�..� <br />IIEIGIIIIIMIinipll � NOIX�WCI��.i1u <br />I � I V.rc <br />IX'CIiPNKv vLLs5TME5 I�CUI'�N�IO.�D <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />�Vy iwn C//Iq}{+(lj'-"-.,7J6-Dcib' �10NVITPi <br />� <br />I I HERE�Y CERTIFV TNAT I NAVE READ AND EXAMINED THIS <br />—� APPLICATION AND NNOW TME SAME TO BE TRUE ANO CORRECT. ALL <br />PROVISIONS OF lAWS AND OPDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITN WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTMER STATE OH LOC/L LAW RF.GUUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWNER OF TMIS PROPERLY TO PEPFORM TNi: WOPK FOR WHICH <br />APPUCFTION IS Mqp� AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1027 PCW AND 296.200 WAC. <br />✓ ��� G�k/� <br />X <br />_ snN�c ouc�— <br />CIiY BU5�1kS5lILCNSE NJ <br />MOOD <br />.�%' �� �� U - pS <br />�+uarsn[ FEES <br />"''vC5 [] �ro BUa�rcA't <br />w e�oc; r i <br />m�s <br />RVMB�NG <br />4CC11111ICM <br />� -oi*qnu ni.n o�¢+ <br />omw <br />St�i[ BUrtDR+G SVUCN�AGE <br />CITY OF EVERETT we�c v.m+s <br />LOCIIL SALES <br />TA% CODE IS �105 iOTAL <br />r[[ lactFivirq <br />L�3 . c1 / <br />