Laserfiche WebLink
rnsew�ar.�n �-r'PLICATION FO��� � ���,e„ <br />��^°F CONSTRUCTION <br />everett PERMIT � <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 ❑ COMBINATION ❑ BUILDING 4; MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWIIEli MAILAO�NE55 CITY 21P �XpNE <br />�Ur'� uri�. ��.•,�-:',' � � i� '�!lk�. . r'7 !r '1 �' /iii �l E�-:�Lf:'F:7` �� �Pre-_ �1 ��'�r ���(!_tl'l:a-F—� <br />APCHItECTOB0ES10NEN ' MMIADORE99 CITY 21P PHONE <br />OENEN�IGONTNRCTON M�IL�OORE99 Cltt ilP PNONE LILENSE• <br />MECNANICAICONiMCTOq MRILIUORE95 Cltt ilP G'F2J L�fNpNF� IICENSE• <br />(" <br />�I�'rrr..G'i'I'-iY�: I I�.�"�.iP.r...,inl`i , i/ lr C���%1 i�=�/ti�l !\J Al(- -(il-f�(11i_P:�T. ����, �;'%=L��;':; 1� <br />PLUMBINOGONIOACTOfl MAIL�OORE99 CITY ZIP PIIDNE LICENSE� <br />�IC �.� ��-,�isl � %� (t \ .� <br />C1R59 OF W011K I <br />� NEW ❑ ADDITION O_ ALTERAiION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING PELOCATION <br />VALVATION OF WOIiY. (C09T OF lAp1ERIA�3 PLUS LAOOfry <br />� DESCRI9E WOHK <br />0 <br />G <br />8 <br />r- <br />Oi BUILDINO <br />�or-- <br />PPOJECT�OONESS <br />i�'.��_) `��.I <br />HEATEH <br />l <br />�--�--X� n�L.if1 �i��J(.�.)�1L���'� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOW THE SAMETO BETRUEANDCORRECT.ALL <br />�� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WIIL BE COMPLETED WITH WHETHEq SPECIFIED HERE� <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHO(iIN TO VIOLATE OR CANCEL THE PROVISIONS Of <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIG�II�RE OF ONTFAftiTOR OR AUTHOPIZE� AGENT DATE <br />� p ) 1 <br />X� �_� _.�.:1�/'1'i i,;��l_t r'� - i ����C�s <br />'.ICAL <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />ACC.OV <br />REFfi <br />LOTAREA <br />PLANS GMECKEU BY <br />ey <br />VACANT SITE <br />OYES ONO <br />FOR ISSURNCE BY <br />Bl11LDINO <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />.. , -.. �.... . .. . . �. <br />PIAN CNECK FEE <br />FEE RECEIPT NO. <br />VA�IlATION FEE <br />E <br />. . :��F (_. . . . <br />