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�';�PPLICATION Fa:�_"`1' <br />Ih�Ewrylwn CONSTRUCTION <br />urr oF <br />everett � PERMIT <br />BUILDING DEPARTMENT <br />259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWN MAILRODRESS Cltt ZIP PHONE <br />��'EN E'YS OPF'i�r (�ZoW�TS I�fOS iEuFlzc�rAn�� f.•�y Ev6zc-i't' <br />�FCHITECTOfl0E510NEfl MAILAODNESS CITY 21P PMONE <br />OENEMLLONTMCTOfl MAILAODPE55 Cltt ZIP PHONE <br />�r�, tie� �N� Pa. g� �� cy�aWoo� 48�yb ��6 �s�s 3� <br />MECH�NICALCONTMGTOfl MAILADDPE55 CIiY ZIP pHONE <br />SIGN <br />LICENSE • <br />..� .. <br />�ICENSE � <br />FLUM9INGCONTfl�CTOit MAILqD�RE55 �Itt 21P PIIONE LICENSE• <br />i OF WOHK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />�or—e�oc�— <br />ADONESS <br />FFONT9ETBACN <br />USELONE <br />�PPLIG�iION �GC. <br />� <br />7 S/GvuS vN wrt�L..�b�k /D' 3o'X26 � 3'X �o� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIED HERE- <br />IN OR NOT. THE GRANTING QFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY OTHER STATF OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. � <br />SIGNAT OFCONiRACTOROR NORIZEQAGENT DATE <br />X �G� �• V""-_ 1/` ��/! // �L_ <br />�PPUCRNTS GRY BUSINE55 4CENSE N0. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSGNNEL <br />GROUP <br />BY <br />VACAN751TE <br />pYES ONO <br />NO.OF DWELLINO UNITS <br />Lo�D <br />0 <br />FEES <br />EUILDING <br />PLUMBINO <br />MECHANICAI <br />OTMER <br />PENALTY <br />TOTAL <br />FEE RECEIiTNO. <br />V�LUIITION FEE <br />S <br />SILf,�c..0 �d-t-� �� �CU.Frd <br />�aYB7 �' <br />