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� �y <br />q�M <br />H�� <br />�C O <br />� <br />�tl N �tl <br />VJ H <br />xp <br />Oty-�d <br />��g <br />Qr n <br />ry� <br />g�H <br />H <br />��fA <br />`�� <br />� <br />I <br />I �� <br />u <br />. I�•J �\n <br />APPLICATION�IFOR CONSTRUCTId�:/ RERMIT <br />TO BE COMPLETED IN INK—PLEASE PHINT <br />n�o e��,p,eo,� <br />ciTr or <br />everett � <br />BUILDING DEPART�dENT <br />259-8810 <br />I DEMOLITION I I COMBINATION <br />1A�R �0�11E55 <br />HEATING SYSTEM: U GAS � ELECTRIC ❑ <br />f I BUILDING <br />cnr <br />everett <br />� <br />I I PLUMBING ❑ SIGN <br />� yL� M4RAO�nE55 GTV � ZIP FIIOHE <br />�0��` CIIY ZIP PI/ONE <br />AnC1UlEGTO110E5iGN[R A1NL�OOBE55 <br />ncucnni cn��1MCtOR MAIL�OOf1E55 GITY 2iP PMONE LICENSEI <br />I NEW �ADDITION ; �ALIERATION <br />oescniae wor�K ni+o sounne voouce rt+vavco <br />! REPAIR I I pEMOLITION I_ I WOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br />CONiAGt PERSON AND PNONE N0� <br />.! _ 11 .�.... .. i/.'f �'f �O r <br />rnoraseo use oF omioir�c <br />pFK'lc+� <br />ieont oescmrrro�i or rnoPenrv isrwwn ociow oe nnncN roun cories� <br />�o� . oiocK or <br />FOR OFFICE USE ONLY: <br />1'RONi5E1BRCN BERR; <br />IISE <br />;¢e <br />OR <br />TOTAL S <br />�11T S <br />�L FEE S <br />SIDE <br />LOTAREA <br />ALLaW?BIE '��EOfGONSi.AUUAL <br />s. r+o. ov siomes <br />LOAD FIRESPf1NhlERSflEO� <br />OY �UNS�PPPOVE�BY <br />�---� <br />I HERFAY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE THUE AND CORPECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITN WHETHER SPECIFIC-D HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PflOVI510N5 OF ANY <br />OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />nWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH <br />APPLICA7IUN IS MADE AND I COMPLY WITH THE STATE <br />CONTFACiORSIAW 18.27 RCW AND 296200 WAC. �IIC l0/ <br />SIGNALUREOFCONTlUCIORORAUtNOARED�OENT OA7E 7�� <br />X AMGDO+tilt47Mil <br />1U1��•.�l��,a_ S•xi /Nc. X 4-I-4�. _ <br />APPIIGnNTSGItYEJ5ME55UCEN5EN0.AN0 SMESSNrME <br />UNIT NEATEFiS—B.T.U. M <br />8 <br />HEAT PUMP <br />GAS PIPING <br />BUILOING <br />p[NCA4C� NJMMi[IIINGUXI�S <br />cuao PLUMDING <br />BnSEMENt MECHANICAL <br />H[IGIIiLIMRRPON �DDITIONALPLANCHECK <br />OTHER <br />STATE BUILDIN� SURCHARGE <br />CITY OF EVEflETT PUBLIC WORKS <br />LDCAL SALES <br />TAX CODE IS 3105 T�Tp� <br />SUB TOTA! S <br />J <br />flECEIPT N0. <br />