Laserfiche WebLink
,�PPLICATIO�J FO�i' <br />ne EvarprN� C O N e T R U C T I O N <br />Itt OF <br />Pver�tt �ERMIT <br />TO BE COMPLF��ED IN BLACK INK- PLEASE PRINT' <br />iUILDING DEPT. <br />59;Q745 - ❑ C':MBINATION <br />t�re.n i;..r. Sl��. .. <br />WNEII MRIL �D�liE55 <br />everett <br />e <br />BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ 51GN <br />zm •��^� <br />�,F}-. %J'//$ 52"�-��'u'J <br />/ /u. ///c/ � ..r...l . � � Gltt . .�. _.._.._ <br />uCiIiIECTOBUE910NEP MAILAOOPE9S . <br />.[tIER�LCONIRACT00 MAIL�[1URE55 <br />CIIY I�P PIIONE LICENSE • <br />C�n, Z�p PIIONE LICENSE • <br />�ECIIAIJICALCONiMLiOq MAIL�OOflE^v5 <br />GItV ZIP PMOIIE IIGENbS � <br />WM01116CONTiACTOP M�IlR00flE55 � . <br />] NEW ❑ AODITION <br />OF <br />ALTEPATION ❑ REPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRPL.INSERT ❑ BUIIDING RELOCATICN � <br />_ .� <br />v�us �naoni � <br />m <br />, � �-� .. <br />w � I HEflEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />�� ")RI(?` pLICATIONANDKNOWTHESAh1ETODETRUEANDCORRECT.ALL <br />IOFPIIOPiRTV�SMOWNBELOWOR/1TTACMFOURCOPIES) OFWORKWIL�LBE OMPLETOEDWI H VHFTfi�V9SPEl:FIEDHERt <br />_oF IN OR NOT. THE GRANTING OF A PERMIT DOEu NOT PRESUME TO <br />APJYOTH1ERSTATEOR OCALLOAWREGULATIIJGCONSTR�UCTION <br />OR THE PERFORMf.NCE OF CONSTRUCT�ON. <br />SIGNATURE OF CONTR4CTOP OR AUi110PIZED AGENT DATE <br />x.._ �GF��--,��^ � ,�/�%/�' . <br />GS^IICEN NO. � <br />naeci�ooa�ss EV{-aT%� WIAI/ Wc� <br />� S. e.:' • �/c�� � - <br />OF EOl <br />N.P. EA. <br />EA. <br />THIS PORI'ION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />RONT SEIOFGK�_ <br />�:i[ ZONE <br />[,— � <br />� YP[ OF CONST. <br />T- �1 <br />�a2[ OF�B/L06. <br />/Y �� �S � <br />FIRE 5?RINKLEfi: <br />�i�VLIC�110N AGC. BY <br />�•� <br />� /) <br />REF <br />N../d . <br />� <br />�L � <br />VRCANT SILE <br />OfE9 �j�0 <br />NO.OF DWEI <br />0 <br />L •G <br />�S��y� � � <br />��� <br />FEEB <br />BUILDING <br />PLUMD�NG <br />MECHANICAL <br />OTHER <br />PENPLTY <br />TOTAL <br />�3 <br />FEE �y � <br />VALOATION <br />s <br />iCE <br />`VJ <br />8 1 I `• <br />.� .-� <br />-1 -n <br />�. -i <br />�n x <br />� <br />0 <br />m ci <br />c'.; <br />-i c_ <br />o "3 <br />--I z <br />m� <br />S7 z. <br />c <br />n -i <br />r x <br />H 1--I <br />� � <br />� <br />� <br />oD <br />3 <br />= m <br />fTl N <br />O <br />or <br />c� m <br />c <n <br />3 � <br />m <br />Z Cl <br />-i r <br />• m <br />➢ <br />A <br />-i <br />_ <br />➢ <br />Z <br />1 <br />2 <br />N <br />Z <br />O <br />--i <br />C'> <br />fn <br />