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���:iPPLICATION FO.: <br />'°``�"°'"'° CONSTRUCTION <br />an ov <br />everett PERMIT <br />EUII.DING DEP�RTMENT <br />259•8745 TO BE COMPLETED IN iNK- PLEASE PRINT <br />❑ DEMOLITION <br />C <br />❑ COMBINATION <br />LD `.'� �65r. <br />I8'BUILDING ❑ MECHANICAL <br />an xir <br />evcren <br />� <br />O PLUMBING ❑ SIGN <br />rrror�c <br />3Ss'- o5�y3 <br />cer�En�lCor��neL�on u�a�onncss enr zir ruoHc Zy�, ��s� liGF115E. <br />/Yi��/1/Di -/'�Fic/'Y c,�•Sr. ��,. aay ti�ck��SoN :, i• SERTi�e wr3 �i f/as Mc��l6yD,t <br />MECIUNIUICONIRA�IOq 1AAL1100f1E59 CIIY ZIP PnONE UCENS[• <br />PWMO����3COMf1�G�bf1 M�I��UDP[Sg CIIY 211' �IIOHf tICC115E• <br />cUsS o1 wonK <br />❑ NEW ❑ ADDIiION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOODStOVE/FRPI.INSERT ❑ BUILDING RELOCATION <br />v�t IIONO�WOnKiC09iOf�.utCPi�l9PW4L�BOn� <br />� it�n <br />usE o� BWloiNo ' <br />� ES i � v2Ati'T <br />�caa r[sa��rnoN oa vnorEnrv isr <br />�t: oitn�qGG Tb SW CcRNEQ nF �ni*-NSR�u iwoF , <br />'I /(.0 � b/)1� . Si �U i•ftC . A�CS'fe%' f- To r. r i r r i,J�C <br />cor¢s <br />PROJECf�ODRE55 �����_ _ ����.A� ��� ,.�Q,�/ <br />I HEREBY CERTIFY TliAi I HAVE flcAD AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BETRUEAND CORRECT. ALL <br />PROVISIOPJS OF LAWSAND OFDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETIIER SPECIFIED I1ERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO <br />GIVE AUTfiORITY TO VIOLATE OR CANCEI THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION <br />OR THE PEFiFORMANCE OF CONSTRUCTION. <br />5101UiURE OF CONfRApTOR /O�R AUiHOR12ED FGENT OATE �/ <br />X / !' �//f.laU lL. ���� /� �/ <br />C�iY0U5WE55lyJf115E Np <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />� nonr se�o•cn <br />n5E 20r�E <br />fYFE OF LONSi <br />tiRE Of O1�0 <br />OCCU�ANCY Gf10UP <br />0 <br />V�CANI SIIE <br />❑YES �NO <br />NO.OF OWEL <br />�I'PP • pq <br />to�o <br />DUILOIN6 <br />rwMowc <br />MEGHANICAL <br />OTIIER <br />PENALTY <br />TOTAL <br />FEES <br />FEE I �ECEIPI N0. <br />VALUAi1011 I fEE <br />i <br />