Laserfiche WebLink
InsEwrO�� ��P�LICATION FO._ <br />arrcc CONSTRUCTIOfd <br />everett PERMlT <br />BUILOING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />everelt <br />� <br />❑ DEMOLITION ❑ COM8INATION ❑ BUILDING ❑ MeCHANICAL ❑ PLUMBING �iSIGN <br />OWNER MAILAD�PE55 CiT' ZiP PHONE <br />U.S.w�rr�=R,v QV➢NRF_/ 9os 5.6i_ac,z�r7'..vA�ti�.aY i=y�xsii' 9b'Zo�l 3�'� -�'Ly(e____ <br />nRGHREGTOR0E51GNER MnLLA00PE55 GTY ZIP PHUNE <br />GENERAICONiRAGTOR MRiLn0�PE55 Lltt ZiP PMONE �iCErvSE� <br />SUPERma Fefc �:�v. jii� i�isr ni.i�. P�,�ivaa•^ <<����� ,f�l-c+�;,i SvP�sREf{/Y7�h' <br />MEGHANICALCONTPAGTOq MVLNO�PESS CIiV 21P PNONE LICENSE• <br />PLUMBING CONTRAG:OR MAIL ADDRE55 CIiV 21P PIIONE LICENSE � <br />�T' NEW ❑ ADDITION ❑ ALTERATION ❑ AEPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRPL.INSERT ❑ BUILUING RELOCATION <br />VnLU4TION OF WORK �COST OF MATERIALS PLUS LABORI <br />�'z��� ,oa _ <br />OESCIiIBE WOFN <br />/hi,�!'N�t � F /[L <br />usE oF eullolNG <br />Cl.oY�H.�NG' STaRC <br />LEG4L DESCRIPiION OF PNOPENTY�SNOWN BEL01Y <br />nooeess <br />S i= <br />(. <br />RINAL <br />SINK 8 DISP. <br />e N �v,ti t.L <br />I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BETFUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHIS TYPE <br />OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED HERE• <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TU VIOLATE OR CANCE� THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />$IGNATURE OF GONTRACTOR OR AUTNOR17E0 AGENT �ATE <br />X �•-�- I.,�.c� �//'�%P7 <br />NNAGE EA <br />HEATERS—B.T.U. M <br />THIS PORTION TO BE COMf'LETED SY BUILDING DEPT. PERSUNNEL <br />FFOHT SET�nCn <br />USE 20NE <br />ttPE OF f.ONST. <br />Sil.[ OF PIpG. <br />FIRE SPRINKLER <br />APPLIChT10N ACC. BY <br />LNECNEO BY <br />VACANT SITE <br />OVES ONO <br />APPq. <br />BV <br />BUILDING <br />P�UMBINu <br />MECHANIC4L <br />OTHER <br />GENALTY <br />TOTAL <br />!•�3�7 <br />FEES <br />PL�N CMECR FEE <br />GEE RELEIPt NO. <br />VALUATION FEE <br />5 <br />�/�jr,V ,�-LL O�ed <br />� <br />f �2/U,�-- <br />