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in. e»ro�»^ <br />wn or <br />everett <br />BUILDING DEPARTMFNT <br />259•8745 <br />�.:PPLICATION f0��' <br />CONSTRUCTIUN <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION <br />r� <br />❑ BUILDIN(3 ❑ MECNANICAL <br />❑ PLUMBIN6 <br />� <br />C�ry j�p PNpNE IIGENSE • <br />MAIL��OPE!! _ _ � . w�" "" '_. __ _ � w _ . an.._ <br />PLUMBINOCONTP�GIOB MUU�DREl9 CITY d1V PIqNE LICEHSE • <br />Of Y ORM <br />NEN' ❑ AODITION ❑ ALTER�TION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVEi�RPL.IN9ERt <br />..��e u1nov.rn¢� nI MAII lll�l•v FLUS L�BORI <br />� <br />�or�eioc�—or <br />❑ BUILDIN6 REIOCATION <br />I HEREBV CERTIFY THAT 1 HAVE READ AND E%AMINED,THIS AP• <br />PLICATION AND KNOW THE SAMG TO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCESOOVERNINO THISTVPE <br />OF WORK WILL BE COMPLETED WITH WHETHEH �PECIFIED HERE- <br />IN OR NOT. THE (3RANTINO OF A PERMIT DOES NOT PRESUME TO <br />�IVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br />ANY OTNER STATE OR LOCAL LAW REOULATINQ CONSTRUCTION <br />OH THE PERFORMANCE OF CONSTRUCTION. <br />H16NATURE 9F CONiR�CTOR OR AUT110�F EO �OEN1, D�1E <br />X � / n . _ /!L� I "�,.� X '7 — / 6-�6 <br />THIS PORTION TO BE COMPLETED BY BUILDIN� DEPT. PERSONNEL <br />SEIB�CN <br />SIORiES <br />e[C <br />l�\ <br />SIDE BETB�C <br />WG/NT SItE <br />OYFN f]NO <br />NO Of OWEI <br />M�M OLG ll <br />�PPN fOR i; <br />OUIIDINO <br />PLU��BIN6 <br />MECN�NIC�L <br />OTNER <br />PEN�ITY <br />f0T11L <br />f <br />REGF.IPI HO <br />VALII�TION �[! <br />��e�l�', `�-�•Z48� <br />%�v�J �•-e,` e.v Pk-tvd7b PRt�'�Y <br />