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APPLICATION FOR �verett <br />'"'E""°"'" CONST �'TTION � <br />ci*r or <br />everett PER <br />BUILDIVG DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITIO�: <br />O COMBINATION <br />❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />� CITY ZIP PHONE <br />•qtNiTE i RDESiONER M�ILA�pRE04 � CITY nv rnove ��^-C[-� �1 <br />Y ✓J d� <br />6lNEPAILONiRAGIDN M�I�AODRESS ='ITV 21P PIIONE y!)'� L 4CeN5': <br />- � . _ c /.� � , c--1� � _ l.l i i „�� �n � .•l /� V c�r.-: :.i�v .�14�/ CCC ' ic� ' <br />21P F PHONE <br />PLUMBtNOCONiRA�TOH MAIIApORE59 CITY 21P PIIONE LICENSE• <br />CL�99 OF WORK <br />Q�NEW ❑ ADI:I'10!! ❑ ALTERATION ❑ REPAIR ❑ UEMOLITION C� WOOpS70\IE/FRPL.IMSERT ❑ BUILDING RELOCATION <br />V�LU�TION OF WOHk �C09T Oi MRIERULS PLUS UBOR� <br />%1' C '�U cx� - <br />DESG�f { E W iK <br />n _ . . .0,. .`. . 0 2r1 wt �3 I £ K -- - <br />�5� <br />tor6G <br />PROJECTAOORE55 <br />� �� �S� r�t�L !l <br />CLOSEi <br />THAV <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW iHE SAMETO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORC)INAYCEu GOVERNING i HISTYPE <br />OF WqRK WILL BE COMPLETED WITH WHETHEf7 SPECIFIED HEFtE• <br />IN OR NOT. THE GRANTING OF A PcRM1T DOES NOT PFESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANC:EL TFIE PROVISIONS OK <br />ANYOTHER STATE OR LOCAL LA�W REC;ULATIN6 CONSTRUCTION <br />OR THE P�E�RfFORMANCE OF COIVSTRUCTION. <br />SI6NATOPEDFCONTFACTaBORAOTHORIZEMAGEHT� ORTE <br />X <br />� <br />�/... '. <br />2� <br />7HIS PURTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FqONTSETB�CK F[ARSEIBACN SIDESE%TBRCK P�ANccc111G��lIIEGKNOMBEH PLRNCiIECNFEE <br />�fl� I �-��/ �[.� / �//W�rJ- FEE Il�?O_ AECEIPTNU. //�� <br />USEIONE LO�pNER VACANTSITE <br />�_ 1 OYES ONO f-EES VPLVAiION FEE � <br />��_ <br />NO. <br />Vr\ I I'• l <br />LOAD <br />r1PPH. FOR ISSUdNLE BY <br />BWLOING <br />PLUMBINQ <br />MEGHPNICAL <br />OTHER <br />PENA�TY <br />T0TI1L <br />S <br />