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- APPLICATION FOR CONSTRUCTION PERMIT � <br />TO BE C�LETED IN B�ACK INK—PLEASE PRII ^ <br />BUILDINCi DEPARTMENT HEATING SYSTEM: ` GAS l] ELECTRIC O � <br />259-8810 <br />❑ DEMOLITION O COMBINATION ❑ BU.ILDING �MECHANICAL p PLUMBINQ O SIGN <br />�to� yn �qef g6�/,Z x'� v� rr :wav �Gv {" 98,�a3 7� �-S 2€"�-j <br />ieYwr� _ w�a�ooua p�rv z. naMe . <br />NID �Ol1�lE FOOT�OE NVOLY� <br />�� a maE�rr �a�am ��av on �rt� <br />lOt woGt OF <br />��enr�ucia.rurwen <br />TELERN7NE NIIIMER <br />FOR OFFlCE USE ONLY: <br />aioMran�ac na�naEre�cK <br />MNt[ �Y <br />wn <br />� <br />cin zw <br />CITV ZIP <br />CITY ZIP <br />0 <br />:"� VES .- NO <br />occuw�t� xo a wrtu�rc i <br />c�wr <br />O VES ❑ NO <br />CITY OF EVERETT <br />IOCAL SALES <br />TIU( CODE IS 3105 <br />VMORF BTATE <br />li.�.::3 <br />LICENlE / <br />LONTAGT ►ERSON IIND N10NE N0. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO TMIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES 60VERNINO T}IIS TVPE OF <br />WORK WILL BE COMPLETED WITM WMETHER 8PECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL TME PROV1810N8 OF ANV <br />OTHER STATE OR LOCAL LAW RE6ULATINf3 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORREO BV TNE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WMICH <br />APPIICAT10N IS MAOE AND 1 COMPIY W!TH TME STATE � <br />CONTRACTORS LAW 18.27 RCW ANO YYE.Z00 WAC. <br />Y � d��-I� ���r-� �l� <br />soruiu�T� aTE <br />GAS <br />FAN <br />UNITS—H.P. <br />BUILDING <br />PLUMBIN� <br />MECNANIC�L <br />ADDITIONAL PUN CMECK <br />OTHER <br />STATE 9UILDING SURCHAROE <br />PUBUC WORNS <br />TOTAL <br />FEE <br />T <br />tl <br />