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1�� Evuqresn <br />Cltt OF <br />ever�tt <br />BUILDING DEPARTMENT <br />259-8745 <br />':::PP�ICATION FO��' <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />everen <br />� <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />OWNER MRILAOORE55 QIY ZIP PIIONE <br />•IICNI�ECTOAOE910NER MRIL��ORF99 GIIY ZIP PIIONE <br />MrtrruEw� e.� �Ibnl,e�l �llJ /S,— AJf 5 dt3�an/ .SEArrLE °�IOy (v��-9_3� <br />�ENERALCONIR�CIOR M4ILADU11E95 CILY 21P CIIONE LICENSE• <br />COrJ57E'uC�7LrI �5scvat65 _$�h ,�I:iR Gf��Jn/w�C�.D �1A• 9,i'D3(„ 77�•.Sf1.21 � <br />MECN�NICALCONfRACIOH M�IL�DORE55 CI ZIP PHONE 4CENSE• <br />PLVIABIN0001l1RAqOq M�ILP�OtiE55 CIIV 21P PIIONE LI�ENSF• <br />Ac�;� �ss,v�[�a� �'cu,a�lns a�lc &:x .�r£�_ C�A�rlan,� ,r� 98e�y 3:�:,�y�s3 �ev�c�►�i9�PG- <br />cuss or won+ <br />� NEW ❑ ADDITION ❑ ALTERAIiON ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVC/FFPL.INSERT ❑ BUILDING RCLOCP.TION <br />VRLU fIONO�WOPH�CO510FMM1�Li11AL01'WSLNOORI <br />�,��a� F L _ <br />orscmnc wonK <br />PROJ[CfnODBE55 <br />WATE.: <br />BI OG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE uAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONS Of LAWSAND OFiDINANCES GOVERNINGTHIS TYPE <br />OF WORK WILL BE COMPLETED WI7H WHETHER SPECIFIED HEqE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STqTE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATl1flEOFCONIRACTORORAUTHOfll2[DAGENT DATE <br />��\ <br />FEE <br />IT <br />�' <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />IIEAfi <br />NO Of SIORIES <br />VAC�NT SIiE <br />❑Y[5 fi'NO <br />MAR.00G LORD <br />PUN CH[CN NUMOEfI <br />fEE <br />FEES <br />BJILDING <br />PLUMBING <br />MECHANICAL <br />OTHEfi <br />PEN�LTY <br />TOTAI <br />f <br />RECEIPL NO <br />Y�LUATION � FEE <br />:. . . � � � . .. . ' � � . .. . _ .� . <br />