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xC <br />J x <br />yCy H <br />tHxy <br />HzH <br />�H3W <br />�] H Ht <br />x EnH <br />CO9 <br />0 �y <br />H LT7 0 <br />LO • O <br />a-qR <br />r z <br />HH <br />gy <br />HH <br />Ci�yii E7 w <br />RR tT <br />Z H CA <br />Hi '` VN <br />APPLICATION <br />FOR CONSTRUCTION <br />PERMIT <br />LjTO <br />E COMPLETED IN INK —PLEASE PRIN <br />tna Ew ynorn <br />CITY OF eve re <br />}`}l HEATING SYSTEM: GAS O ELECTRIC 0 <br />BUILDING DEPARTMENT <br />259.8810 <br />DEMOLITION COMBINATION <br />BUILDING JMECHANICAL <br />HONES <br />��LUMBING <br />I <br />SIGN <br />Uci� 2 <br />_„�,e MAK ADORES& t <br />CT <br />1C�i-1 G. C ...... __'. ! I /4 _ <br />I q tTlll I I <br />LOT <br />\lam L MI rl I 1Ck <br />^_. ADDITION C. ALTERATION 1 REPAIR <br />Kil <br />9TY ISHOWN BELOW OR ATTACH FOUR G <br />0, <br />FOR OFFICE USE ONLY: <br />LOT <br />BY <br />ZIP <br />PHONE LICENSE P <br />PHONE LICENSE• <br />ZIP <br />DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />CONTACT PERSON AND PP! -1 . pl_ <br />3-q 0�- <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 GOVERNING THIS TYPE OF <br />NWORK OT. THE GRANTING COMPLETEDL BE ISPECIFIEDTH WHETHER HEREIN <br />GRANTIING OF APERMIT <br />RMI DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTP.UCTIC'J OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />WHICH <br />AAOWNER F PPLICAOTIONISIS PROPERTY <br />ANO IE COMPLY WITRFORM THE H KR THESTATE <br />CONTRACTORS LAW 18 27 RCW AND 296.200 WAD. ,l p <br />SIONATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE Il] iq / <br />X;; <br />APo <br />PLICA TS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />BTU M EA <br />M <br />METAL FIREPLACE B CL-1--:. <br />BUILDING <br />JM4UN�I1 <br />PLUMBING <br />MECHANIC <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />IETT <br />PUBLIC WORKS <br />ES <br />3105 <br />TOTAL <br />FEE <br />5 <br />