6500 EVERGREEN WAY ST VINCENT DE PAUL 2016-01-01 MF Import

rM ewrorwn CITY OF everett BUILDING DEPARTMENT 259•8745 APPLICATION FC�R CONSTRUCTION PEItMIT TO BE COMPLETED IN INK- PLEASE PRINT everen e ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ,�(SIGN OWNEH M�ILAOUPE55 CITV 21P PMONE . S�T VIfV�Ehr D PqUL �cSCJO EVE12GR8EN unt.rVf21: .1flGHITECTOflDESIGNEH MAIL�D�flESS Cltt ZIP PI/ONE t1��eu nr r_oni co. _ GENEML M�IL � yN�v- . N PLUMBINOCONiRAGTOR M�ILApDRE59 Ci'.Y 21P PIIONE IICENSE� � VNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUIIDING RELOCATION V�LO�TION OF WOHK ICOST OF M�TEHI�LS PW 9 LABOFI � 5 (?"'U ' = OESCRIBE WORK K�F'�r�nr�ainrrK)1N 7�x/o' D�� N�t Sf�dinf 5�5`i ort exrs�`�ny F�cln �or` �. ..��1 �J7i� TYPE OF CONST. I HEREBY CERTIFY THAT I HAVE REAL'� AND EXAMINED THIS AP• PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT. ALL COPIE57 PROVISIONSOFLAWSANDORDINANC'cSGOVERNINGTHISTYPE OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS 0� ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTFiUCTION. SIGNA7l1flEOFCONTRACTOpORAUTHORIZEDAGENT OATE l � ,U�,y/�b x APPLICRNTSGITY NE554CENSEI:O. �vE�GGr�—v�% �d`f EA. M EA. THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL AGQ BY LOTAflEA VACANTSITE OYES �NO OCCUP�NCYGflOIIP NO.OFOWEI NO.OP STOPIES MAK OCG LC aED ❑ YES ❑ NO PLANS GHECNED BY APPH. FOR I: BUILOING PLl1MBING MECMANICAL OTHER PENALTV �?� I TOTAL 1 0 • �3 ��6 FEES �CU,U 7'J i�/2lU,d7C- PLRN CMECN FEE fEE FECEIPTNO. V�IIIATION FEE 5 � � LL- ��N /�,L-'6}�-�'-T;