Laserfiche WebLink
, . .a�^, , <br />`�•' APPLICATION F'��JR <br />tne Everpreen C O N S T R U C T I O N <br />ciTr oF <br />everett PE RM IT <br />evcrett <br />� <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING � SIGN <br />OWNER MRILAOOFESS CITY ZiP PIIONE <br />c- � n c-.- w qqq �pp /��,r S'�t�mf 98/O5� 6�11'-3.ZDo <br />A PHpNE <br />�RCHITECTORDEBIONER MAIL�DOPE99 CITY ZIP <br />GENENRLCONiPr1CTOR MRILADORESS CIN 21P PHONE LIC�E/N�SE• <br />... —_ .ii / i _ ""'.� .�� .i/%y /�.�. �_in � `��i� /.��J�_'-�G.�� /�L/.flii�14.77/1_!1� <br />Zip PIIONE " UCENSE • <br />PLUMBINGCONTflRCTOfl MAILApOfiE55 CILY ZIP PIIONE LICENSE+ <br />;LA55OF WORN <br />D� ucW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />LOT� <br />SISE OF <br />b A� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BETRUEAND CORRECT. ALL <br />FOUIiCOP1E5� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILI BE COMPLETED WITH WHETHEFiSPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERfvt1T DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />AMY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAiI'RP OF CON�RACTOR OR AUTk10R12ED A6ENT DATE <br />X�� � �"�'"`� '--rs- <br />J � Mi/ <br />M <br />CLOSET <br />FAN <br />T <br />M <br />THIS PORTION TO F3E COMPLETED BY BUILDING DEPT. PERSONNEL <br />LY <br />OCCUPANCV GNOl1P <br />NO. <br />SETBAGK <br />VACRNT SItE <br />OYES ONO <br />NO.OF OWELLING <br />RPPR. FOR <br />n[6 s� <br />9UILDING <br />PLUM6ING <br />MECHANICAL <br />OTMER <br />PENALTY <br />TOTAL <br />lABER PLFt! CIIECH FEE <br />FEE RECEIPiNO. <br />FEES V/IUATION fEE <br />E <br />.�✓-1L1.(� r[7 �� /-�.L-c_.. o. <br />P2lU�'� �� F�Y. <br />I`l,� (J2ca1 �-z� m � n ���'L <br />r��„ � <br />z <br />0 <br />-� <br />.. <br />n <br />r <br />., .. <br />--I T� <br />�--� � <br />�' m <br />C O <br />mo <br />n <br />O 3 <br />m <br />t- <br />_ -� <br />m <br />A Z <br />C <br />a -+ <br />r x <br />.-. .. <br />--I N <br />K <br />'*1 <br />oz <br />-n n <br />3 <br />—i m <br />x <br />m� <br />0 <br />N <br />or <br />c� m <br />C (n <br />3 Vi <br />m <br />Z c") <br />—I r <br />• m <br />a <br />z <br />--1 <br />2 <br />n <br />z <br />� <br />x <br />N <br />Z <br />O <br />—i <br />n <br />m <br />