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APPLICATIt,.d FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />. 3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />❑ DEMOIJTION ❑ COMBINATION ❑ 8 ILDING �AECHANICAL ❑ PLUMBING <br />PROJECT ADDRESS: � ❑ SIGN <br />O !,✓an e�/�/le � ab <br />OMNER <br />MNl�00RE55 <br />"� ^�+�R �RE FOOT�pE M <br />-- /N S � [, i � <br />_C�tG �'a P�A <br />PIIOr09ED USE pF��� <br />_ Sr /", �. <br />�aK oeseavraN a onovenn tsawn e <br />�or �� _ <br />Cltt <br />arv <br />C �/N , <br />QTY <br />GIIV <br />�q dB �/�OS �tJ p� <br />IOMI LENOEN.I10ME55. TELEPIIp1E MMEER <br />FOR OFFICE USE ONLY: <br />FIIONT SETeALK M�n � <br />11EIONT LIMT�TION <br />a�cu�r�ncr rq n <br />LOT�RE� <br />r+o a owewna <br />UNIfS <br />I o�rE <br />L' <br />� <br />S <br />SIDE SETB�CI( <br />nr PMON[ <br />�� /% %b�2D 2 �� D (o � .Z3 .� -D ir�o <br />IIP punuc ♦ <br />O/ ) % �/� � <br />' } ��03 <br />ST�TEr�X� � � _ � <br />HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COqqECT ALI. <br />PROVISIONS Of UWS AND OROINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITM WHETHER SPECIFIED HEREIN Oq <br />NOi. THE ORANTIN(i OF A PERMIT �OES NOT PRESUME TO 61VE <br />AUTHORI7V TO VIOLATE OR CANCEL rHE PROVISION Of ANY <br />OTHER STATE OR IOCAL LAW REODUTINO CONSTRUCTIpF� pp TME <br />PERFORMANCE OF CONSiFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WOqK FOR WMICH <br />APPLICATION IS MADE ANp I COMPLY WITH THE STATE <br />CONiRACTORS 8 CW AND 298200 WAC. <br />�„ � 3 <br />D�TE <br />pTT E�$INESS IICENSE 1q. <br />� <br />DL`lii <br />PIAN CIIECN <br />V��NT $IfE <br />❑YES ❑ NO p�p���Nf. <br />siie or eioon i <br />�t11MBIN6 <br />3�MENi 4ECH�NIf.�I <br />❑YES ❑ NO <br />•ppII10N�1. M AN CN(CN <br />on�en <br />STAIE BlnlplN6 SIIi1GN�p6E <br />CITYOFEVERETT ruBiir.wp�Ks <br />IOCAL SALES <br />TAX CODE IS 3105 7orA� <br />SUB <br />fEE �qK,E1PTNp <br />