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APPLICATIC--1 FOR CONSTRUCT''1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT '— <br />259-8810 <br />I7 DEMOLITION I 1 COMBINATION <br />OYMF.R _ MAILAD�RE55 <br />HEATING SYSTEM: J GAS ❑ ELECTRIC U <br />I1 BUILDING }���F=�HANICAL <br />ZIP <br />1L �' "" " -- CITY ZIP rn�nv <br />TENRNT MFILA�DPE55 <br />C�ry Z�p FHONE <br />ARGNITECTORDESIGNER MML�ODRE55 <br />PLUMBING <br />-2209 <br />❑ SIGN <br />���, Z�p PNONE STATE UCENSE • <br />PWM91NGCONTRRCTOR MAILADDRE55 _ <br />GONiRAC�RICE %F YpRN <br />� 7 <br />DESLNIBE WORN RND SOURRE FOOTAGE INVOlVEO <br />akt otii' ol,d � 4'�Ru� � �,vsno� <br />'AS FuRNA�E� # No� wA�FJ� Tp�i� <br />PROPOSED U5� � BNL�ING <br />LEG�L DESCRIPTION OF PROPERTv ISHOWN BELOW OR ATTACH TWO LOPIESI <br />�p7. BLOLN OF <br />PpRCELTA%ID.NUMBEA <br />CONSTPUCTION IOAN LEI <br />� <br />8 <br />FOR OFFICE USE ONLY: <br />FRONiSETBRCK REpR' <br />JSE 20NE <br />iYPE Of LON57. <br />SIZE OF BLOG. <br />OGC7PRNGYI <br />REASON <br />INTRNE BV <br />LOT AREA <br />NOAF STORIES <br />FIRE SPRINKLEFS REO'D <br />$ <br />SIOE <br />CONTACT PERSON �NO PHONE NO. <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 CaOVERNINti THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />AU�THORITYRTOTV OLATEAOR CANCELETHE PR VES ONS OF ANY <br />PERFOR 1ANCE�OF ONS RUCTION.�THAT��I AM AUTHORI ED BY THE <br />OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />PLAN <br />l^I <br />AIR <br />'PUMP <br />pIPING <br />VALANT SRE �' <br />� YES ❑ N� BUILDING <br />occuP�ur xoaowEuir�eux�rs <br />eAow pLUMBING <br />BnSErneNr MECHANICAL <br />❑ YES C NO <br />HEIGNt UMITAiIor+ ADDITIONAL PIAN CHECK <br />OTHER <br />STATE BUII��NG SURCHARGC <br />� CITY OF EVERETT PUBLIC WORKS <br />ILOCIIL SIILES <br />nv rnnc is a�n5 TOTAI <br />DATE ..... ____'_ _ -- <br />@J <br />SUB <br />FEE <br />-2u�9y <br />n <br />X <br />� <br />