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'�-�PPLICATION FO��i <br />In� Er�rp�sen C O N ST R U C T I O N <br />GIT OR <br />everett PERMIT <br />qUILDING DEPARTMENT <br />25s-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />O OEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECNANICAL <br />i it7 c`i >. � 7 / �/j �/f <br />nrretl <br />� <br />O P1.�MBINO ❑ SIGN <br />v��or�e <br />(_�� �0.2 ,' <br />�����,E <br />n1 �_/l!/]l�. / 9U P <br />r,tru[nucOHtn�c�on m�awm�esa �••• -- p- -- <br />(��_ �` � ��)� /��� <br />NCCH<NiUI COq1RedOq MAR �O�RE55 Clrv 2i0 PupqE L�CE��SC • <br />�IUMBi11�GOM���GiO� M,UL�U�PE59 CIN 2iP PnONE LrCEnSE• <br />❑"NEWV O ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOODSiOVE/FRPL.INSERT ❑ BUILDINF�� RELOCAitO�J <br />vaivaio� or wonn icosr or rn•¢n�nis rtus ��eon� <br />✓�/�i�'o v <br />OESCRiBE\YOPK .� <br />USF. Of <br />IEG�t <br />ieoonEss <br />���I i <br />BIN6 <br />WAT <br />rioon <br />�r� <br />PEOrCtoa <br />ia���-, .� <br />c <br />�' �. .,, , � <br />SINK <br />I HEREBY CERTIFY 1 HAT I HAVE READ AND EXAMINED TNIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUE �NDCORRECT. ALL <br />PROVISIONS OF LAWSAND OFDINANCES GOVERNING THIS TYPE <br />OF WORK WILL �E COMPLETED WITIi WHETHEH SI'Ef;iFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT NqESUME TO <br />GIVE AUTHORITY TO VIOLATE OP CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL IA�V REGULATING CONSTPUCTION <br />OR THE PERFORMANCE OF CO�STRUCTION. <br />SIGNAtUAEOFCONTRAC70RORAUi110fi12E0AG@NT DA7E <br />X��., /P�'�,�� /����5� <br />r.vauc�ers cirv <br />CG71 <br />0 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />R[POS[19�CR SIOESEiBACK PLANGHECKN6'AOER PLANCHCCMtEE <br />/'(� [ <br />/ ���Ii, Cp , �W/r70� fEE �� RELEIFINO � <br />LOI��G y� ANTSIiE <br />FEES V�LUATION FEE <br />-- t� � �r �ES ONO <br />t <br />JU � <br />OCCIII'nNCY GOOVP <br />�=-� <br />NO O/ 51 ONES <br />� <br />BY <br />UNIIS <br />��,, � �' � � ' �. <br />BUILDIN6 <br />PLUMDIN6 <br />MECfUNICAL <br />OTHER <br />PENAIiY <br />T0TI1L <br />'T-,r7)'���`f ".�. <br />. <br />