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:��:;�PPLICATIOf� F06'�:>> <br />r„•Eyaromn CONSTRUCi'ION <br />cm oF <br />evereti PERMIT <br />BUILDING DEPARTMEPJT <br />259•6745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />�7�e �Estz� <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />Mall AD�flESS <br />V111 <br />cin <br />���rcn <br />e <br />❑ PLUMBING ❑ SIGN <br />PHONE <br />PHOIIc <br />w,�. �i ��_a 2s�-�- <br />PHONE LICENSE • <br />MECHANICALCONTMCTOfl MAIL�ODflE55 CIIV � 21P PNONE UCENSE• <br />PLUMBINQCONTHRCTON M�ILAOUHE53 CITY 21P PMONE .. LICENSE• <br />CL�SS OF WONK <br />� NEW ❑ AOD�TION ❑ ALTERAT�ON ❑ REPAIp ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINO RELOCATION <br />V�LtIPTION OF WORK �COST OF MATERULS PW S lRUOP� <br />3� �.�CO!� .Oa ;��1�/1-� � <br />�or- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW TH E SAME TO BE TRUE AN D CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCESGOVERNIP7GTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. � <br />51)CyLR�RE OF CONTRACiOF OR AUTHORIZEO AGENT DATE <br />EA. <br />LAUNORVTRAY <br />DRAIN <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />G � <br />iZONE LOTPRI <br />C—( <br />E OF GONST. OGGUP� <br />�' � /-F�/ �' <br />=oFeioa ,/� NO.OF <br />�CI _ �7 "1 <br />VAC�NT SITE <br />pY!$ ONO <br />G. LORD <br />fGQION ACG BY PLANS GF:ECRED 9Y APPq. FOR ISSU�NCE BY <br />�r� ��� L �c <br />euaoiNo <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTV <br />TOTAL <br />F[E REClipTNO. <br />FEES VALU�TION FEE <br />� : <br />�.� <br />s �10�_��.i_ �rt.��G 4 <br />;, � <br />