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<br /> 3200 CEQAR STR��1', �V�R�7T,WA 9820�
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<br /> BtJIL.DIN�AREA.{If residantial,new construciton,ramadel,ar addition} S� '
<br /> lJiLbEN�TYP�: C�SFR A�TAGHED L�5FR ATfACH�D ❑DUi'LEX I�MUI.71-�AMII.Y-#OF[1iV1TS: �Q CQ3VlMEI�CIAI.,
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<br /> CpNTRACT F'R[C�OF WORK:$ . i
<br /> i�U11IIB�R OF 1]�ViC�S ifi law�oEfiage :•
<br /> F1RE AtA4�M� CI Y�S NO
<br /> ASSOCIATED BUI�DIHG P�f'tM1T# ifa plicable):
<br /> p�SGR[P7IO1V C►E WORK:
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<br /> QWNER NAflIiE: 'T'EN�iNT NANi� If CammerclaI): �[� �
<br /> OWN�R MA[1.1NGADbRESS: s�e� gQJ� •
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<br /> OWNER PFEON�: qWtJER�WfAiL:
<br /> COAITRACi'O:R.IJAM�: � G+� / II..�
<br /> GONTRAGTDRAUDRESS; srR�r /rd �D1C
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<br /> CON"F�iAGT012PH�N�: �j'"'2 7'' K' CO�iTRAC1'OREfl![A[L: ,�"/Ey,�. m�''�R I �r, CD�
<br /> CQN7'RACTQI�i..CC,#{REQUIR�D}: ������ '��,z CkTY O��11�1�T7'L�U5I1�iESS LfC.#{R�QUIRED):�Q
<br /> PRINlARY CONTACT: ❑OWN� V �1rCONTRACTOR CI OTH�I�(Pteass 5pecify) •
<br /> COiVTACTNAM�: CQidTACi'pH01VE: ZUf�'7�jL�"'CpS��p .
<br /> . ��N��� C�.aUI �o�A���m��. D� �l rS.��.ou1� l�t�'vv�1T. �on�
<br /> AQR�EMENT.•T hereby aerdfy that!have read and examined ff5ts applicaifion and hnowfhe same to be frua and corr�ct A!!provislons offaw,s and ordlnances governing ihis
<br /> [ypa of work wlUbs comptefed whetherspeclfied here/n arnot The granttng of a permtt doss nuf presums io give auflwrltyfo vlalate or cancel the provls�ans of any ofherstate or
<br /> locallawregulating corrstn�c�lan orfhe performAnce of constructlnn Thaf!am aufhorhed by fhe ownerof�hTs property fo parform the woric for whtch appUcaflan fs made and!
<br /> compiy�lfh ihs State Confrdcfors Law 98.27 RC]Nand 29�2Dd Wi4C.
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<br /> Ownari u orized Agen Signature Date (Revlsed i0�1?J2D96)
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