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rn. ewrprwn <br />ciTr oF <br />everett <br />BUILDING DEPARTMENT <br />2a9•8745 <br />`���-�APPLICATION F�R <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />���rcn <br />e <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL O PLUMBING �IGN <br />OWNER MAILqDDPF.55 L CITY 21P PMONE <br />�V„ lTy�/ C' i^�aZ 1��'I �C �'L%%�/lAu-f. l.,�e.L. .�-...+�r �.• <br />GENEfl�LCONiH�CTOP MRIIRODRE55 CITY ZIP PHONE LICENSE• <br />L3P�2/L`F /�/L'-E'�v Cc� 1`�J !�o /3t3.� S.LG.ai L`�i�ii/ � <br />wif LQ'�fG %�68"�3i iic,t�i�Y�v2v� <br />PLIIMBINGCON:P�CTOfl M�I�ppOlIE55 CITY 21P PIIONE IICENSE• <br />CLA53 OF WORN <br />� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />W LUATION OF WOiiK � WST OF MRTEPULS PIUS LABOfi) <br />� i0� .if� � ".� <br />DESCRIBE WORK <br />�-.� c� oL �1�T71r-L �! i � � 2" X 2 d � /%/F %n �+o- 4.v i �/un, /.,,wY>.aQ /'v/d v S; � � <br />USE OF BWLOING <br />LO7_BLOCIL_ <br />OF <br />�CC. <br />5����� I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP- <br />'BELOWORATTApMFOURCOPIES� PLICATIONANOKNOWTHESAMETOBETRUEANDCORRECT.ALI <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OP. NOT. THE GRANTING OFA PERMIT DOES NOT PFESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. � ' <br />SIGNATURE O jCONTRACTOR Oq AUTHORIZED AGENT OA�E <br />HZL <br />FEE <br />l�, <br />��lY'�$r6 <br />THIS PORTION TO BE CONPLETED BY BUILDING DEPT. PERSONNEL <br />VACRNT SIiE <br />�YES ONO FEES <br />Y0. OF 0 W ELLINO UNITS <br />2UILDING <br />NAX OCQ LORD <br />PLUMBING <br />MECNANICAL <br />OTHER <br />PENRLTY <br />IPPR. FOR ISSU���ryryry C BY <br />� �' TOTAL <br />�!•l4Da <br />FEE I RECEIPi N0. <br />V�LU�TION � FEE <br />.�lLt,cl Tb �3E ,��-� c�.J <br />Pt�t�,a� P�E�Q-�j' <br />