Laserfiche WebLink
p E,,,,o,,,,,' '�..PPLICATION FO.. <br />everett CONPERMITTION <br />BUILDINO OEPARTMENT <br />259•8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBIN(3 <br />�'SI(iN <br />OWNER M�ILADURE53 CITY ZIP PNONE <br />.�l�L S'TA [! (/1'e/t o 9/.5 ? C�,�ro.�rr-�� ����r��v}� 9b''.zn �s 3 5`S-? Y t�1 <br />�RCNITEGTONOE IONER MAIL�UORES9 Cltt ZIP , PHONE ���r ,�d(J <br />YLUMBINOGONTR�LTOR M�IUDDNE33 LI7Y 21P PIIONE IICENSE• <br />CL�39 OF WOPN <br />�NEW ❑ ADUITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />V�W�TION O� WOHK �COST OF MATERI�LS PLUS UBOPo <br />600 � <br />AESGRIBE WOPK <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAMETOBETRUEANDCORRECT. ALL <br />�CNfOURCOPIE51 PqOVISIOPlSOFL/WSANDORDINANCESGOVERNINGTHISTYPE <br />4Y' OF WORK WILL BE �OMPLETED WITH WHETHER SPECIFIED HERE• <br />I N OR NOT. THE GRAIVTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHOFITY TO VIOIATE OR CANCEI THE PFOVISIONS 0� <br />f ANYOTHER STATE Ofi LOCAL LAW RCGULATIN6 C.ONSTRUCTION <br />OR THE PEFFORMANCr OF CONSTFUCTION. <br />�cfcP�v /Do d �� �ri /2 <br />%Fa�'�'S lJ,'u:ties�Y%%n�.olet <br />p �r sY// :7.•v:s:o•.�'/ <br />SION�TURE OF CONTRRCiOfl OR AUiHORIZEO AGENT DATE <br />Xci„ � �� <br />AIR <br />AIR <br />�� <br />FAN <br />NO <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />