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APPLICATION FOR CONSTRUCTION PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SVSTEM: ❑ GAS ELECTRIC ❑ _ <br />259•BB70 <br />: i DEMOLITION '� I COMBINATION .�. BUILDING � MECHANICAL � PLUMBING SIGN <br />OWNEfl MARIipDFE55 Ci1Y TiP PnONE <br />nD,J �8, �3z� j2 �c s l E�rr �S3- 2ssr <br />iENANi MAM1MDPE55 LpY :'P PNCNE <br />�9CIIII[CiOfIDE9GNH1 MARPO�FE55 LIiY ZiP VNCNE <br />GENEPµCp1iMLIDfl MAII WDPE55 CIIY ZIV VIqNE SLAiEIILENSE� <br />MECHN1qi1LCCNiNAGlO3 M�RMDPE55 GI1Y ZIP PWYF. <br />_SGSt/iE�i H,6�'�l6 /�aA G�i�/ur �d 6il�JT eJ4•9$Zoa 3_t33iK� <br />PWMBINGLd1iPACiOfl MA0.ADOflE55 GiY ZIP PNpNE <br />GUSSOF WOHK <br />''�. NEW ' RDDITION ALTERATION REPAIR OEMOUTION � V/OO�STOVbFRPI INSERT <br />�/� CONLACL FEPSON /JIO PHONE NO <br />CONIMLI PPICE OF NqRN /�'� <br />LEWL DESCflIPLION OF ppOPl <br />�o� eiocr <br />SGiE IIGENSE • <br />:�N/�Noa <br />SUiE IICENSE • <br />BWLOING RELOCATION <br />I HEREBY CERTIFY THAT I MAVE READ AND E%AMINE� THIS <br />APPLI�ATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />.owoeet.ncerwncoriesi PROVISIONSOFLAWSANDOflDINANCESGOVERNWGTMISTVPEOF <br />WORK WILL BE COMPLETED WI'.H WHETHER SPECIFIED HEREIN OR <br />oF NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUT40RIiY TO VIOLATE OR CANCEL THE PflOVI510NS OF ANY <br />OTHER STATE OR IOCAL LAW REGULAiING CONSTflUCTION OR THE <br />PERFOFMANCE OF CONSTRl1CT10N. THAT I AM AUTHORIZED BV THE <br />OWIJER OF THIS PROPERTV TO PEflFOR'd THE WORK FOR WHICH <br />APPLICAjfON IS MADE AND I COIdPLY WITH THE STATE <br />COMTRO�fORS LAW 1827 RCW AND 295200 WAC. <br />FOR OFFICE USE ONLV: <br />FpCNiSEIMCN FEAPSEiO�CN <br />USE2WE lOiAFEA <br />�rvEacaxisu�mv.a�E naorcoxsnnwi <br />SIZE Ci OLDG NO Oi SiCPIES <br />ULIIF.WLVWI.O FIPESYPNNL[flSflE <br />METAL <br />$IOESELB�LK PLANCMECNNUMBf{L <br />?� ��3 0� <br />vecnrvrSnE FEES <br />BUILOING <br />pSipA4[Y NOpIMILLiN�iW'IS <br />�ppp° PLUMBMG <br />BeSeuEM MECHANICAL <br />�iEicHiuuttni�on p�01T10NRLPLANCHECK <br />SPqINNLER <br />STRTE BUILOING SURCHARGE <br />CITY OF EVEHETT PUBLIC WONNS <br />LaCAL SALES <br />TA% COUE IS 3105 toru <br />8 <br />