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riPPLICATION FOk-. <br />EVEFlN <br />emOF <br />CONSTRUCTION <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />❑ <br />COMBINATION Cl BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />OSIGN <br />OWNEI' <br />Cltt zip <br />MAIL AODRE89�J awf UB l Z/ <br />L�iF-J,'S[.r J,'I•�I[- �f ^FRS, <br />PHONE <br />44 - 7520 <br />UF1Uc/k� <br />,.2`1Ul <br />ZIP <br />PHONE <br />ARCHITECT OR DE910NER <br />COV <br />MAIL ADDRESS <br />GENERAL CONTRACTOR <br />CITY 21P <br />MAIL ACDRE59 c'A <br />Snti,E A,r �/ SE.Arn-G /�Jl33 <br />PHONE <br />Qi 4z <br />jLS <br />LICENSE <br />SSS r[,crr3/cJ <br />�) I�A.E <br />CJ. <br />l3/So <br />ZIP <br />LICENSE IT <br />MECHANICAL CONTRACTOR <br />CITYPHCNE <br />MAIL ADDRESS <br />CIfV ZIP <br />PHONE <br />LICENSE• <br />PLUMEINO CONTRACTOR <br />MAIL ADDRESS <br />C AA/y Of WORN <br />❑ ❑ REPAIR ❑ D;.MOLITION [IWOODSTOVE/FRPL.INSERT BUILDING RELOCATION <br />Id NEW ❑ ADDITION <br />ALTERATION <br />4. 300c) L, <br />E WORK IAJSrAL(. <br />LL TEA. 17�1° /•,FT.tir. /CWI,, f'c`.c SIbwJ //l.lu <br />WILDING <br />E12VILt JT•Arlutil <br />PROJECT ADDRESS <br />I S.E• 5,44.R nlALL <br />30 <br />3 � 4.lE S.E. 4' .Eec/r- /U,41I- tAj : <br />SIDE = ZZ3• Z TDTAL- �C.'FI S,AE`i <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO. <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />OR ANYOTHER OF CONSTRUCTION. RTREGULATING CONSTRUCTION <br />SIGNATURE OF :ONTRACTO/ROR AUTHORIZED AGENT DATE <br />x V/L,,t- -7- /0-IS71- <br />APPLICANTS CITY EU9INESS LICENSE NO, <br />AIR <br />T <br />M <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />REAR SETBACK SIDE SETBACK FEE RECEIPT NO, <br />LOT AREA VACANT SITE FEES VALUATION TEE <br />OYES ONO <br />BUILDING I <br />SIZE OF RLDG. NO OF STORIES MACOCC. LUAU <br />tPENALTY <br />FIRE SPRINKLEF,._ ..EOUIRED ❑ YES O NO <br />BY <br />FOR <br />L` TOTAL I I <br />14-67 <br />