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.-, <br />ApPLICAT14./ FOR CONSTRUCT.JN PERMIT �� <br />TO BE CUMPLETED IN BLACK INK—PLEASE PRINT a9�"T <br />3UILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC ❑ <br />t59-8810 <br />DEMOLITION COMBINATION BUI�DING MECHANICAL xPLUMBING i I SIGN <br />�WNER MAILADDRES:� CITV Z�P PHONE <br />EXF� �LLV<<. 323 S�.'-�CC�¢t1PN(ZO'-Bk���..t���nn �Y1i24 (3vo) lull-ZZlr7 <br />FN�NT MAIL �OORELo dTY ZiP PHONE <br />��nGHITECT OR DESIGNEB MNL ADDRESS CITY ZIP PNONE <br />t'�' ,� M-ec,>a l301 3rvtax•i �wt-Evrec��' `�82c3 (260) 353-28aY. <br />:[NERALCONTHAGTOR MnILADDRE55 CIiY 21P F4:NE STATEUCENSE� <br />7�� SANE n< a��e <br />+C�IC�LCONTRnGT09 M�ILAD�RE55 CITY ZiP PHONE ST�TELICENSE� <br />M�IL ADORE55 <br />XNEW ' ' A�DITION i . ALTEFlATION <br />ST�TE LICENSE � <br />! REPAIH i i DEMOUTION � WOODSTOVEiFRPL INSERT I 1 BUILDIN6 RELOCATION <br />CONir1CT PERSON AND PHONE NO. <br />ONTR�CT PRICE OF WOP!( � c.f� (/, �� p <br />f.SCR�BEWORKANO50URPEF00TAGEINV IVED�NSTALI���\�T� � <br />F�¢.r r�iLcrta.���.� SNST�H- 4 Ba��o�.,yS <br />ROPOSED USE OF B1:1l01NG <br />IIGAl0E5CRIPTION OF PqOPI <br />pt BLOGN <br />� <br />U7:L\IJ <br />oc <br />S�t� <br />3 �oS ".� _ <br />/ <br />Ii„ 0 �� �1: �/C� '� ,�: <br />;,�n 4 ZS2 tev., s./ �u�iT <br />OrF <br />r� <br />)F FIKTURE OR ITEM FEE <br />:T (TOILET) <br />� <br />�SH BASIN) i <br />8 DISP � <br />'OR OFFICE USE ONLY: <br />NONT $ETBRCN RE�B SETORCK <br />SEZONE <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAI. FEE $ <br />ALLOWPBIE � IYCEOiCON51 ACtUPI <br />�i: O� OLDG. <br />iIRE S��NNLERS REOD <br />�[nSON FOR SPRINNLERS <br />9TRn[AY PLANSAPPROVEDOY <br />�A�'1 %11 � <br />VACANT SITE <br />o�curextr xoamvauur,uxrts <br />cnavv <br />O�SEM[NT <br />NEIGNT UAIIT�TION <br />CITY OF EVERETT <br />LOCAISALES <br />TAX COOE IS 3105 <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALI. <br />PROVISIONS OF LAWS AND ORDINANCES GOVEPNINO THIS TVPE OF <br />WORK WILI 8E COMPLETED WITH WHETHER SPECIf1ED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATM;. CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORI2ED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM TNE WORK FOR WHICH <br />APPLICATION iS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />X � /- �0-9 G <br />s . iun[ o�*E <br />#3vz�l�o• <br />HEAT <br />BUIL�ING <br />PLUMBING <br />MECNANICAI <br />ADDITIONAL FLAN :HECN <br />SPRINKLER <br />STATE �UILDING SURCHARGE <br />PUBLIC WORKS <br />8 <br />M <br />M E.A. <br />RECEIPT NO. <br />X <br />� <br />