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,�.E�.,o,„� % -PPLICATION FO�_ ' <br />��TM�F CONSTRUCTION <br />everett PERM�T <br />BUILDING DEPARTMENT <br />259•f3745 TO BE COMPLETED IN INK- PL'cASE PRINT <br />�DEMOLITION ❑ COMBINATION BYIILDING ❑ MECHA�ICAL <br />)WNER M�ILPOORESS C�tt :.IP <br />�+-u�� G � : « 3s� �� �G � L-vererr %s�zo/ <br />iNLn11i/tEC50R0ESIQNER /�% MAI�F`DDPESS �� CITY 21P <br />/!/cPTin�/Id/ /"/4vl J�l�Li�� 1�//l' <br />i Of VIORN <br />NEVt ❑ 4DDI?�Grv ❑ ALTERATION ❑ REPAIR <br />OESWiBE WOPN � <br />c <br />PROJECi�DDRE55 <br />3 <br />SHOWER <br />�RAIN <br />OF <br />sue <br />s <br />21P <br />❑ PLUMBING <br />PIIONE <br />2 S.�-� 3 <br />PNONE <br />evcrett <br />e <br />❑ SIGN <br />LICENSE • <br />UCENSE • <br />u[FNSE . <br />DEMOLITION ❑ 1NOODSTOVE/FRPL.INSERT ❑ BUI�DING RELOCATION <br />CT/O ✓1 , I 0 � \ � o <br />I HEREBY CERTIFY TNAT I HAVE READ AND ExAMINED TfiIS �P• <br />PLICA?'lONANDKNOW THESAMETOBETRUEANDCORRECT.ALL <br />PROVISIqNS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPL[TED WITH `NHETHEF SPECIFIEO HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT?RESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAI LAW REGULATINGCONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTH4CTOR OR AUTHOPIZEU �GENT pAiE <br />I X /7� _ __ .��-� �d`� � , <br />CITY BUSW [55 UCENSE NO <br />AIR COND. <br />T.11. M <br />EA. <br />'�"HIS PORTION TO BE GOMPLETED BY BUILDING DEPT. PERSONNEL <br />iROhf5Et04CR PEARSEIBACnH SIpESEiBAGN PLNNGHEGNN❑/MBER PLANC��ECNFEE <br />_�' �`�'-'�l L�'/ ��II / I�II! I fEE '�C��If1ECEIPiNOC <br />USEtOHE LOT�PEA V"' � I/ Vv � � <br />n 2 VACPNiS7TE FEES VALUpTION FEE <br />/,( - _ ) OVES �NO - - - _ _ <br />ITYE Or GONST. OCCUPANCV GROUP <br />v- m <br />S12E 0� O1�0 NOAF Si0RIE9 <br />3..� i SF � <br />V'� � <br />PLRNS CIIEGNE� BY <br />S�� <br />OCG LOAD <br />FOR ISSURNCE dY <br />V •�' <br />BUILOING E <br />PLUMBINO <br />MECHANICAL <br />OTMEf1 <br />PENALTY <br />TOTAI <br />—l���F>�� . .... .. . "idR6d-- <br />wilh zonin�, ;EPA nnd c:iscretionary <br />�permit requirem_nis. , <br />Date <br />° � y '6 <br />,�`��+v-uu <br />