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�.aPPLiCATION FG{.t <br />""E»"°"'° CONSTRUCTION <br />an ov <br />everett PERI�IIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION 41 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OrWNER / I MRILPODRES$ CITV ZIP PNONE <br />F.'��f� ���/iiuf ((4 /l <br />OESIGNEA <br />r• . I <br />� C � Cti <br />ROORE55 <br />Gltt <br />CIiV <br />�.11c� <br />21P PNONE <br />u � p�v» ; <br />ZIP PNONE <br />UCENSE • <br />it�u�iA � �k <br />�sn�1L <br />�ILENSE • <br />PLUMBINGLONTPRCTOR MRILAODPE55 GITV ZIP PIIONE UCENSE• <br />CLA55OF WORK <br />❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />ryy�L WTION OF WOFK � WST OF MATERIALS PLUS LABOPI <br />• 1 _ � w A _ . <br />USE OF <br />ior_ <br />aooaess <br />� <br />E^� i Ciw <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT.ALL <br />FOIIPCOPIESI PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />— OR THE PERFORMANCE OF CONSTRUCTION. /� <br />SIGNATUFE OFCONTRFCTOp OR AUTHORIZED AGENT DATE ��/V�CI �6 <br />X r� <br />c�..� c � <br />M <br />AIR <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSrJNNEL <br />FRONT SETB�CN RERR SETBACN SIDE SETBACK PLAN LNECN NUMBER —� PLAN CNECN FEE <br />USE20NE <br />TYPE OF CONST. <br />OF <br />RPPLICATIONACC BY <br />M-�' <br />LOTRpER <br />OCGUPRNCVGROUP <br />NO.OF STORIES <br />7E0 ❑ YES ❑ <br />PLANS CNECNED BY <br />WC�YT SITE <br />7YE8 f1Np <br />NO. OF DWE�IING 11NiT5 <br />MA%. OCG LOAD <br />APPR FOR ISSURNCE BV <br />G�� <br />8Ca ! 7 �i5 �' <br />FEES <br />BUILOING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENFLTY <br />TOTAL <br />FEE C(�� I PEGbPi NO. ¢!i� �// <br />J O o �7 �i <br />VAIU�TION FEE i <br />