Laserfiche WebLink
In� Mrpmn <br />CII'/ OF <br />everett <br />BUILOINC DEPARTMENT <br />259•8745 <br />�::��4PPLICATION F(7� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />eraetl <br />e <br />❑ DEMOLITION ❑ COMBINATION ❑ BUIIDIN(i O MECHANICAL ❑ PLUMBINQ �iSION <br />OWNER M�It�DORE09 CITY jlP PNOHE <br />nm �us cv. �ooi �v �3iu,�n���fr su,T-� �-�it c�vrr �,.,r� <br />U1CNI�FGIOPOFf1�011[11 MNI�ODNF!! CI�Y ZIP PIION[ <br />OEHEP�LCONIRI1CfOR MML�ODREl9 CI1Y ZIP PNOHE LILfN9E• <br />B�Yt�tY NLiri�/ct• zr�� Po /Sdx S�Gr CYM� r✓�t 'tga�Yc 776 g83� ��>vcYN 1���n <br />MFC1uN�L��.LONiR�GiOq Me1Le00NCl� GRY i�P PNONE LICFN�F• <br />PI�MliHOCON1R1CtON MMI�DOBEEs CIfY SIP Pi�ONE LiCEMSf• <br />O� WORK <br />NEW ❑ ADDITION ❑ ALTER�fION ❑ REPAIR ❑ DEMOL1710N ❑ WOOD9iOVE/FRPL.IN9ERT ❑ BUILDINO RELOCATION <br />unu nr wnnv �cni r nr u�tl n�1L4 PW] L1eOR1 <br />�j!'� n_ <br />OElC 19E WONK <br />i�1R. rt771/S771iC // 1 2�XSi � S�%/= .i7✓?i77s=.LY''/L .�LGWN . S't6ri <br />�or_ <br />USE [ONE <br />IVPE Of CONSt <br />s��� I HEFEBV CERTIFV THAT I HAVE READ AND E%AMINED THIS AP• <br />PLICATION AND KNOW TH E SAME TO BE TFUE AND CURRECT. ALL <br />)Wp11�ITI�CNfOURCOPIEBI PROVISION30FlAW9ANDORDINANCE300VERNIN6THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HENE• <br />I�' OR NOT. THE 6RANiINO OF A PERMIT DOES NOT PRESUME TO <br />OIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION9 OF <br />ANV OTHER STATi= OR LOCAL LAW REQULATIN� CONSTRUCTION <br />OR THE PERFORMANCE OF CON9TRUCTION. <br />910N�TURE Oi CONTR�CTOR OR �UiHOR12E0 �OENi O�TE <br />I-\ <br />6� Pu1'7a4 <br />AIR <br />THIS PORTION TO BE rOMPLETED BY BUILDING DEPT. PERSONNEL <br />•P�IIG��ION�GC OY <br />IIE�� 9EIB�C6 <br />LOIIREA <br />PL�IIS CIIECMEU BY <br />BIDE <br />MC�Nf BItE <br />OYE! L1N0 <br />BUILUINO <br />PLUMBINO <br />MECH�NICIIL <br />OTHER <br />PEN�LiY <br />TOi�L <br />IC / <br />fEE �ECEIPi NO <br />fEE{ v�L11�TIfIN f <br />f <br />lo'�Lg �$(� <br />