Laserfiche WebLink
M�Ewryn�n -APPLICATION F(,it �Vef�„ <br />��noF CONSTRUCTION � <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEN MAIL�ODNESS CIiY ZIP VNONE <br />.�.,�v.�(.il..(�P TND�f.ST2��� ��v�2�1.�11',�L� r �• ' L��1 '33`t -2(n�G, <br />APCNITEGTORDESIONER M�ILAOORE54 CIIY ZIP PHONE <br />21P PIIONE <br />`�Y�aci ��5`j. <br />21P PIIONE <br />PLU INOCONTP�CTON M�IL110�RE9S ��^ •'r ' <br />�U.ht.A(� �'v.dilSSfLaM� ��Wr�s2! <br />CUSSOF WORk <br />� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOODStOVE/FRPL.INSERT <br />use or <br />L <br />�or_ <br />VNOJEGT�DDRE49 <br />1U2� <br />C73 <br />c� c, <br />IICENS[ � <br />LiCENSE • <br />❑ BUILDING RELOCATION <br />S I� `!S I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUEAND CORRECT. ALL <br />W/NBELOWORATiACHiOUPCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHEq SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />CA THE PERFORMANCE OF CONSTRUCTION. <br />� SION�TUREOFCONTR�CTORORRUTHORI2EDRGENT DAIE <br />X <br />NO. <br />EA. <br />N0. <br />EA. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />USE <br />NN <br />SI2E OF B100. <br />.� <br />�PPL�GATION �CC. BY <br />� �� <br />a�7FR � 2 <br />NO.OF S10RIE9 <br />� <br />7ED ❑ YES �'NC <br />1 UNS CMECNEO BY <br />1J�w�n <br />VAC�NT 51 <br />OYES 0 <br />M�%OCfl LOAD <br />11D <br />I. FOR ISSU�NCE 6Y <br />G�G <br />� �� � <br />FEE9 <br />eui�ou+a <br />PLUMBING <br />MECHANICAL <br />OTIIER <br />PENRLTY <br />TOTAL <br />PLAN <br />� <br />� � � � <br />V11LU�TION <br />uJK1P-L' b7�:�7t� t� ,d�.,e�164T <br />c�,.�,��-rrx w� „�,r � <br />�NIt -r. <br />3���G� <br />FEE <br />FEE <br />�43 <br />vv <br />vo <br />