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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 258-8810 <br />n pEUpLITIpN fl COMBINATION fl BUILDING C� MECHANICAL fl PLUMBING fl SIGi <br />ADDRESS /�/ n � <br />��v <br />�o <br />ia ;�L�/� yi�. <br />cm tiP <br />7�y��' i7,E; F <br />LIiY 21P <br />��5- <br />ARCMTECTOROESIGNER MI11lADM1E55 GITY ZIP FNONE <br />������Tpq M�I�1100RE55 GITV ZIP PIIONE ST�TEUCENSE� <br />MECN�NiLALCONTA�T� M�IlA00FE35 <br />p�Ty 21P VNONE STATE IICENSE � <br />� GITY 21p PNONE STATEULENSE• <br />p��y�RqCONTp�CTOR M�IL�WI�E55 <br />�or e�oac <br />PNICEL TM I.D. MIIABER <br />�OORESS, 7E1ER10NE MIMBER <br />8 <br />fOR OFFICE USE ONLY: <br />USE ZOnE <br />HEI6NT UMIT�TION <br />LOTAREA <br />TOTAI FEE S I <br />SIDE SEfO�LK <br />VI�CANT $IfE <br />f1YE5 (1 NO <br />NO OFUWELUNO I512EOFBLOf✓f� <br />UNI75 <br />f1YE5 fl NO <br />HEATING SYSTEM: P <br />CONTACT PERSON 1VID GMONE N0. <br />!J <br />rl ELECTRIC n <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THI: <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNINO THIS T/PE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINQ OF A FERMIT DOES NOT PRESUME TO OIVE <br />AUTNORITY TO VIOUTE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE <br />PEHFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZEO BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TME WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CANTRACTORS LAW 1827 RCW M1U 296 200 WAC� <br />��-5-9� <br />-. �1 D�TE <br />y�w <br />dTY BU9NE55 LICENSE N0. <br />r� � <br />... <br />GAS <br />— B.T <br />FEE <br />PL�N CNECN NUMBf:R FEE I RECEIPT N0. <br />9111LOING <br />PlUM81N0 <br />MECM�N�C�I <br />�pplilON0. PUN CHECR <br />OTHER <br />ST�IE Bl11lDIN6 LURGNARGE <br />CITY OF EVEREIT �'UBUf. WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />