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I�� EwrprNn <br />pn oF <br />everett <br />BUILDING DEPARTMENT <br />259•8745 <br />�:�:PPLICATION FO:_� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BIiILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />4 NEfl M�Il�00RE55 Cltt 21P PHONE <br />..rf�VE $AG�T'�ou� lolo�Z 3�j D25E �UL`RE�'1" 96'Zo(� 33�-9079 <br />[N1���1: <br />6ENEMLCONTRACiOR MAIL�UDHE55 LIIY ZIP PHONE IIGENSE• <br />sRM 1� A5 o Wnlcyz � i� a� ►��k2 �' <br />MECNANIGIILGONTfl�CTOq M�IL�DORESS CIIY ZIP PMON[ UCENSE• <br />O��MB�NOCONTRAGTOP M�IL�OORE59 GIIY 21P PIIONE 4CENSE� <br />CLASS OF WORK <br />� NEW ❑ ADDITIOi; ❑ ALTERATtON ❑ REPAIR ❑ DEn�OLIT10N ❑ WOODSTOVE/FRPLINSERT ❑ tlUILDING RELOCATION <br />fi�,S � ODd °� <br />'�E�ea1S-n2ucr n)n.l S�niG�tr �1f't�c.�! �iLc�! <br />i�E-�+d C€ S� � <br />OFF4CPERTY�SMO\YNB WOR�Ti <br />�Er �� �L t HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THESAMETO BETRUEANDCORRECT..'1LL <br />FOURGJPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHIST'fPE <br />0� WOfTK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT, THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />3 GIVE AUTHORITY TO VIOLATE OR CANCEL THE �ROVISIONS O� <br />ANY OTHER ST.1TE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. � <br />SIONATURE OF CONTRACTOR <br />� <br />EA. <br />AUTHORIZEDAGENT OATE <br />NO. <br />M <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />� "'"" � � �J / <br />LOTARE� <br />- S � ��1 <br />_ � OCCUP CY RC <br />-3 <br />NO.OF STORIES <br />�i� � n <br />C�TIO�gY PUNSGHECMEUf <br />� /� <br />/• S/ <br />Y�C�NT SItE <br />,llYES ONO <br />NO. OF DWELLINO UNITS <br />I <br />�i <br />L, . G <br />O� I Q(��], FEE <br />�� V � lJ <br />FEES <br />auaou+a <br />PLUMBINO <br />MECNANIC�I <br />OiHER <br />PENALTV <br />TOT�L <br />CHEGKFEE <br />V�LIIATION I F![ <br />