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APPLICATIO�� FOR CONSTRUCTIVN PERMIT <br />CITY OF E�[R6TT • pUILDING UIVISION �CA��� <br />32011 CEDAR STREET • EVERETT, WA 90201 • 259•8810 <br />p DEhVOLITION ❑ COM8pINATION BUILDING LI MECHANICAL ❑ PLUMBING ❑ SI(aN <br />PROJECT ADDRESS: �� I p -� S� J i ��` �P f� Cj �'�i � <br />TENNI7 - .•ulM%If�F55 rm !iP-'-- <br />J1a�_ <br />��LIIITf�CT0110E51GNFq MMI�IXIf1C55 <br />\ 1 _� <br />�6ENEIUI DNip�t Ofl M�II�[yt11F55 <br />i/ 1 /I ! n /1 <br />cow�n�tron <br />A i � l GIY. I <br />lEOAlDESCRIPT10NOi �OlrtflfYl�roWNPElOwpl�f1�C11 WpCq'IESI <br />w��_ecux V�Eti� As��r�la.�' !'c�c�.-�u,% �n <br />Vo I• ��I �� PI0.ts c�, p�� 109, �«�.a's %. 5:�:';i <br />CONSTM1CTIp/ ION/ lEN0E11. �pp11E54. TEIEAIONE NUMREfI <br />FOR OFFICE USE ONLV: <br />f110NI5ETR�CIj� / RF.�n50TP�Ck <br />� <br />� <br />U4C IOHE r/� 1 1 OI AOFA <br />/— �/ <br />��E�,��<<1��� ��o a��«�� <br />IINi1G <br />i <br />OGGUP�HGY Iq (M SI(wn(5 Of:CUP�NI IO�U <br />6Rd1P <br />f,oNSr �rinnSenPnr:�fnnr <br />u�i[ <br />� SIOE SF!B�CN �- � <br />�.�.�� 5��� <br />❑YES O Mfl <br />sze a eiuon i <br />3U6 S. F. <br />��SEMFNI <br />❑vF5 ❑ NO <br />ill• �IIONF � <br />--- `yr� --9'''`'o,� - <br />Ji�• P�N)Nf 541ClICCNSE• <br />— -- - 3;s-��y1- -tb���� <br />,C�;�iS._`I�jS���«�F � v ����1Sc i v 3 rN E <br />li�' PIIUNE SI�IE IICEHSE � <br />SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />M� um r�ro�ir No <br />I 11EREOY C[RTIFV THAT I IiAVE READ AND E%AMINED THIS <br />APPIICAIION AND KNOW THE SAME TO BE TRUE AND CORPECT AlL <br />PpOVISIONS OF LAWS AND ORDINANCES GOVEiiNING THIS TYPE OF <br />WORK W�LL �E COMPLIED WITH WHETHER SPECIFIED HEHEIN OP <br />NOT 711E ORANTINq OF A PERMIT DOES NO7 PHESUME TO OIVF <br />AU7110RIiY 10 VIOLATE OR CANCEL THE FROVISION OP ANY <br />OTIIFR ;TATE OR LOCAL LAW REOULATINO CONSiRUCTION OR THE <br />1'EI7FORMANCE Of CONSiRUCTION. Tf1AT I AM AUTHORI2ED BV t1iE <br />OWNER OF THIS PROPERTV TO PEiiFORM THE WORK FOR WHICH <br />APPLICATION IS MADE �ND I COMPIY WITH TNE STATE <br />CONT{iACTOPS LAW IR.27 RCW AND 288.200 WAC. <br />f.IIY OIIGNES51 NJf NSC NO <br />PI �N LIIC/.k MIMIIt p� <br />-`J y1'= <br />ouuuwn <br />r�uunw� _ ___ <br />MFI:II�NIf.�I <br />�INNIION�I PI�NI:IIIf.N <br />owrn <br />su�t nunonm s�urt:nnnar <br />� � CITY OF EVERETT runnr wnn•c <br />IOCAL SALES - <br />7 TA% CODE IS 7�05 _ tOTAL _ <br />, � I nFfE1Pi NO <br />1 <br />U� <br />