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TO BE CONI�ETED IN BLACK INK—pLEASE PRIN� <br />f^ <br />HEATINf3 SYSTEM• AS lU ELECTRIC �,j <br />BUILOINQ DEPARTMENT • <br />2b�-8B10 ' �/ <br />❑ DEMOlIT10N ❑ COMBINATION ❑ BUILDING T�MECHANICAL <br />� <br />lOT KOpI <br />..� <br />a <br />FOR OFFlCE USE ONLY: <br />fIRE <br />p�TE <br />��r <br />cm <br />�� <br />CON7ACT ►ER80N MID ►1�ONE 1q. <br />D PLUMBINO ❑ SION <br />�i 'c�r� 1 �7f'r- cx <br />i NEREBV CERTIFV THAT I MAVE READ AND EXAMINEO TNIS <br />APPLICATION AND KNOW TNE 8AME TO BE TRUE AND COARECT. All <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINQ THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WMETMER SPECIFIED MEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTMOFITV TO VIOLATE OR CANCEL THE PPOVISIONS OP ANY <br />OTHER STATE OR IOCAL LAW RECiUTATINCi CONSTRUCTION OR TFIE <br />PERFORMANCE OF CONSTRUCTION. TNAT I AM AUTh10RIZE0 6Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICN <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />�ON'�CTORS LAW tl.Z7 RCW AND � �� �,/ <br />�Y� � 7 <br />'� YES .^ NO BVILDING • <br />oawa. .o a owtu�a Nm <br />� PLUMBINO <br />�E�M MECNANIC�I <br />❑ YES O NO <br />IRi611TLMi1�T10N ADDITIpNALPUNCHECK <br />OTHER <br />$TATE BUILDINO SURCM�RGE <br />CITY OF EVERETT PUBIIC WONKS <br />LOCAL SIILES <br />TAX CODE IS 9105 TOT�� <br />