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TVPE <br />M�Ewryn�n .�._PPLICATION F01.�' <br />G�YOF CONSTRUCTION <br />everett PE�MIT <br />BUILDING DEPARTMENT <br />259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEIAOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL <br />� M���' <br />❑ PLUMBING <br />� <br />lYtfl�1 <br />e <br />❑ SIGN <br />" _ ___ _ rU /'1�0 /vV _JeT/%/Ki� (.N� �'%d'�/\ Jr�%-.1 UB.S <br />�RCHIiECTOR0E5�ONER M�ILADORE55 CITY IIP PNONE <br />GENERALGONIRAGiOfl M�ILADOHESS CIN ZIP PNONE <br />LICENSE • <br />s�,� � a-ao�:� <br />MAIL <br />ur <br />1 <br />N�W ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FFiPL.INSERT ❑ BUILDING RELOCATION <br />dION OF WOflK � WST OF M�IERI�LSpLUS L�BOR� <br />$ � S. 7 sv °= �"nl�n T- KE'�.r y'S ��iw� <br />IiBE W— 0^q� — <br />� <br />OF <br />S y O �,. <br />S� E✓v� /ha�% i.ln��y Sp�ar.L7 ��g �� <br />DRAIN <br />(r'�D a�3 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE UR CANCEL THE PROVISIONS OK <br />ANYOTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION <br />ON THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAiUR O'ONTRACTOq pq AUTHORIZEO AGENT OA1E <br />X S� o � <br />iPPLICANiSG17Y8 NESSIICEN5EN0. <br />FAN <br />r <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSOlJNEL <br />PEAB:EiBACN SIOESET�ACN PLFNCHECK /NUMBER P�pNCNECNFEE <br />8N /)�� O FEE I I I� J RECEIPI NO�, <br />LOiAPER VRCA�{t �RE (( 1 !, <br />C� � �YES }�jNO FEES V�LUATION FEE <br />CONSI. <br />�'� <br />BLDO. <br />� <br />!J <br />� <br />SiOPIES <br />/ <br />rvO.OF OWELIINa UNITS <br />� <br />MRK OCG LORD <br />w.or r�nrvScntGrcG09Y IAPPq.FOBISSWNCE <br />,� � G.G <br />BUILDING <br />PLUMBING <br />MECHANICAI <br />OiHER <br />PENALTY <br />TOTAL <br />s!S <br />�i <br />