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fM EvMynM <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />��PPLICATION F4�;1 <br />CONSTRUCTION <br />PERM�T <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />!v!rl11 <br />e <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />OWNER M�IL�DDflE55 CITY 21P VHONE <br />/».zQ'/'9•2! %wA►'�cr� iYob' O�•« �'L. �ycxerT 9e�o� 3as- 7.',i7 <br />•RCNIT�ORDE910NEN M�IlA00RE39 GITY LIP PIIOHE <br />� <br />LONTP�GTOq <br />o¢oG- <br />GITY 21P PHONE CENSE • <br />�=',Rvcr,S;E. EYE12tA' �Ie�2c7 3�: 6`J[z� �bEV.r <br />CpY 21P PNONE UCENSE � <br />' VLUMBINOCONfR�CTOR M�IL�ODNE55 CITY 21P PIIONE 4CENSE• <br />CL�SS OF WOPK <br />�I NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BU�LDING FELOCATION � <br />V�W�N OnF WORN�WST OF MQERI�LS PWS UBOfi) <br />/ � � v t_� <br />DESGRIBE WOPK � ,2�', 2�� � <br />r t-ti✓ Gn �zn �o '� I <br />use or em�ou+a � <br />I <br />OFPROPEPTY <br />@ <br />tl <br />i — <br />FRONi5E10�GR <br />- .�J ' <br />USE 20NE <br />� � I <br />R <br />OFI <br />�,_ <br />� <br />t tr� n d�+ Av�, <br />=nTC %,G. 4'i <br />I HEREBY CERTIFY THAT 1 HAVE READ AND ERAMINED THIS AP• i <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL ' <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />pN OFWORKWIlLBECOMPLETEDWITHWHETHERSPECIFIEDHERE• � <br />IN OR MOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OK I <br />ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION I <br />OR THt PERFOR ANCE OF CONSTFUCTION. <br />91ONAiURE OF NT CTOR OR AUTHORIZEO AGENT D�TE � <br />X �/� — <br />, �rs��..a�s�ss�, <br />� �� 0 4� <br />M <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />APP4C�IION �CC. BY <br />�� <br />PEAR SEtB�CN <br />N/(! <br />�f �TIV J'x <br />OCGUPANCYGROUP <br />n� <br />SG <br />OYE9 <br />i <br />0 <br />�o�o <br />i.FORI55U�N( <br />L- G. <br />�'J /�i/�,�^ FEE�/ O= REC61�L11�S� <br />�f� �� (v o iQ <br />FEES VAIUATION FEE <br />a���o�Na � 9� /i� c� <br />PLUMBINQ <br />MECMANICAL ' <br />OTHER <br />PENALTV <br />TOTAL <br />