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,�:E,�,,;,;, ; .PPLICATION FO►.. <br />GTMOF " ' CONSTRUCTION <br />everett PE �tM IT <br />BUILDING DEPARTMENT <br />259•87a5 TO BE COMPLETED IN INK- PLEASE PRINT <br />I ❑ DEMOLITION <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />M�a.00 ss �G �—/�n "'C!T J�d1 <br />�� � � <br />❑ PLUMAING <br />PNONE <br />�a.. l, S.s�- <br />evenn <br />e <br />❑ SIf3N <br />-i�Zl�„ �,� /�J E,�un�� � /�'o � � <br />MECMANILAIGONTP� TOq MAILADDRESS Litt 21P P110NE UGENSE• <br />PLUMBINOCONTPAGTON MAILAD�RES9 CIiY ZIP PNONE lIC[NSE• <br />GUuSOF WONN <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />V�LO�TION OF WORN (W 5} OF MATERIQS PLUS LABOR� <br />/��_�/i dr/O <br />IFRDNTSf:TB�CN <br />USE LONE <br />� � 1 � 1 I HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS AP- <br />� '� �' � PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECLALL <br />BELO�V NATT/� M OUFCO IES� pROVISIONSOFLAWSAN00RDINANCESGOVERNIN6THISTYPE <br />�J� ��,�,� OF WORK WILL BE COMPLETED WITH WHETHER SFECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANC[L THE PROVISIONS OF' <br />ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SI�NATUREOFCONiRACTORORAUTHORIZE0A6ENT DATt <br />�1 (/^� �./"/��...i1 ���. �/.�/�% <br />oF <br />WALL <br />THIS PORTION TO BE COMPLE7ED BY 9UILDING DEPT. PERSONNEL <br />REAqSETBACN SIDESETBACK PL�NCNEtCK MBEN PLANCNECNFEE <br />I A I C,Z(J / 6/ <,p "�� I- J/�I%_ /^ FEE �n PEC[iPT HO. <br />f! � � � 1 � � � \.. <br />LOT ARE� V�GANT SITE <br />� ,� / � � � 'p� S �� cJY[fi ONO FEE9 VALUIITION FEE <br />OFCO�NrS�T OCCUP�NGVGNOUP NO.OFOWELLIN6UNITS <br />�JL_'N R� � I BUILOINQ S/IJi�fM � '% <br />OF BlDO. <br />, /y 36 <br />PUNSCNECNEO BY <br />/� <br />C LOAD <br />� � PLUMBIN6 <br />MECMANICAL <br />oLn <br />PENALTY <br />)P �SSU�NGE BY <br />TOT�L <br />/ <br />: / <br />