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fMErugr��n '..PPLICATiON FO►:�' <br />""°` CONS�"RUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8745 TO BE C0IAPLETED IN INK • PLEASE PRIiVT <br />everrtl <br />� <br />❑ DEMO� �TION ❑ COMBINATION �UILDING ❑ MECHANICAL � <br />owi�cn �l` ❑ ! LUMBING ❑ SIGh <br />MAIL ADDf1E3S ��n, <br />1✓, 1' /��l/� � 1�.Q> . iIP PIION[ <br />v S ti l�' •_27 m u-�. lt� �c�� py �p.0 7 <br />AqOu1tG10P0E5iGNER M�IIADOFESS �y �� � �I T7 <br />� �._. <br />v (� <br />21P <br />/ Z� � � � . / � � 5 G � <br />`� �'^ IIP - PIIONE Q l�CE1RE • <br />��.UAIBi11�ICONIOACIOB M�ILAOOHE59 ..O(��DE � ���� <br />GOV 21P vnOnE — <br />liL[tl5E � <br />Ct A55 01 1'�ORN <br />� NEW L—I ADDIiION ❑ q�7ERATION ❑ FEPAIq ❑ DEMOLITION ❑ 1VOODSTOVE/FFPL.INSERT <br />°���+��o�+o��+aarc�tosrorre��enuisriusineoni � BUILDINGRELOCATION <br />_ "'� �f-�t� q G• .s'dU <br />o� <br />� <br />I 1{EREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCpRRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK Wll.l BE COMPLEiED WITH WHETHEq SPECIFiED hIERE• <br />IN OR NOi. THE GRANTING OF A pEfiMlT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTqUCTION. <br />SIONATUf1EOFCONTRACTORORAUT110RIZGDAGENi U�IE <br />'C/LJJ�CD•� � �:L�S�r-1� G�( }'/ G C`a <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL «" J� <br />� '% . ,i' <br />USE lONE <br />�1• � <br />rvve Or coust <br />U- .�) <br />s�ze or ei oc -- <br />�.��:J , <br />FIRE SPRRIH�' �� ",_{:OI <br />.rruc.n�oiucc er <br />l�j , lUi � <br /><� J � <br />l01 Af1E� <br />xcur.r�cr cnoui <br />. ,, <br />F�- � <br />10 or s1oNEs <br />' <br />EO ❑ YES fj <br />1R+5 piECKE� OY <br />'i '� illj <br />/ i .. � � ! <br />V�C�N SI E ' �� ,I �O I <br />OYES ONO FEES <br />M�K <br />1 <br />BUILDINO <br />rwMaiNo <br />MECIIFNICAI <br />OiliEq <br />PENALTV <br />TOTAI <br />FEE / /� ZU pECEiPI��� <br />VA UATION iEE <br />, ;- <br />-� ,:� <br />= y � n�� ���-:t�� �)rJ <br />.�J ,.l <br />%(' j.) <br />'1.J i-) <br />���,,� � �- <br />' i1 : <br />