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APPLICATiC� FOR CONSTRUC7'`N PERMIT � <br />TO BE .�OMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: h1 GAS J ELECTRIC J_ � <br />255 8810 <br />DEMOLITION ��. COMBINATION '� I HUILDING inMECHANICAL I�IPLUMBING I', SIGN <br />OWNE(1 IA>i:/.Of1�Vf55 �I1V ZIV PNONE <br />QohG�T 9oY0 P.O.F)Oy 2L4'f �.;�;DiUVlrl ygz�� 40L'�770 <br />rc�wxr ur,n�ooaess cirr � zi� v�ror¢ -- <br />nec�nec�oeo[,�eHen � uuieooness urr nn nHoxe <br />GEi:ERtICGNiqALiOP FUM1�pOF[SS �ItV IiV P11q1E ci>lC16E16E� <br />IAELN<YCALCONIflALIOfl /.IL�U�FL55 CIiY jlp pNO4E <br />Gd5/IcAAu(r $nve` M.{-�J M�s.2aE 9f.''z�iz. sr�•e��ccnsc. <br />3�0•]�a.�ac6 ��SNEACT�a�71� <br />rwua.incanaetron usi�eooncu cnv e�r w�wre �rs�=ur,tr�sn <br />cai�A�c'�aK[aFwoaK 'nJ ���OU <br />OESCfl10E WOPN AN� SWAPE iCOGLE INVQVEO <br />__ � �CD IDf{ <br />Zni{A!( �ila5 +�w��nV � /'!i�'i• <br />(� I P / N!r (Z:-' 2AilGf � <br />PIIOo05EDU5EO�BW�OMG y�� <br />IEG�l0E5CPiVtqN Oi P110PEFiY;9�OWN BEIOW OF AiiRL111W0 CC <br />�01 B�OCK 0� <br />rnncEiux�o tm�.�eEn <br />553 � - �oz -ooz -voo i <br />ccrrsmucrior� ioev i�r�oca eooAe:s incr��oric uuuuen <br />a�UTADDRES�9u si — E ue.eerT <br />�i <br />ROOf <br />FOR OFFICE USE ONLY: <br />��O'liSfl(11CN IIEARSEi9ACR <br />u:EIOLE IOiI.PEA <br />ryPFOiCOq51 NDOFSi0HIE5 <br />54E0%6LW FlqESPPiNMlER51 <br />CCLUPANCYlO�D IIIIFAIAPMfl[p0 <br />OIf4xCPV P1r1115 <br />JAIC <br />S�OESEiBACX <br />I:J <br />5 <br />�LO- <br />�3a` <br />I H[REBV CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br />APPUC�IION 4PlD KNOW THE SAM[ TO DE TRUE AND CORflECT. ALL <br />PROVISICNS OP LAWS AND ORDINANCES GO'/ERNING THIS TVPE GP <br />WORN WILL BE COMPIETE� WRH WHETHEA SPECIFIED HEREIN OR <br />NOT. THE GRFFTIIlG OF A PEFMIT DOES IJOT PRESUME TO GNE <br />AUTHORITY i0 VIOLAIE OR CANCEL THE PPOVISIONS OF ANV <br />OTHER 5"�ATE OR LOCAL L1W REGULATIIlG CONSTRUCTION OR THE <br />PERFORAI�NCE CF CONSTFUCTION. THAT I AM AUTHnRRED BY THE <br />OWNER OF THIS PROPERTV TO PERFOPM TliE WORK FOR WMICH <br />APPLICATiON IS MADE AND i COMPLY WITH THE STAiE <br />CONTRFCTORS LAV! 1827 RCW AND 296200 WAC <br />X "� w'�'�'M 3�21/7�ao <br />A�C—A�HN�LG UP��TS—HP <br />FORCED AIF SVS fEmS-8. <br />UNITHEATEflS—O.TU. M <br />WOOD STOVE <br />EXHAl15T FAN <br />. . YES � . NO BwIGiNG <br />X� N�n��tIA��T�S - <br />�"'� PLUMBING <br />B�SEM1�L4f MEGMANICAI <br />VES NO <br />NEiL�rtLiMiletiON AODIIIONPIFIANCMECN <br />0➢�EP <br />5���IE k1 W 101NG SURCIIRRGE <br />CITY OF EVEflETT ausuc wonns <br />LOCALSALES <br />TAx COOE IS 3104 rou� <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />ncc[��r rvo <br />