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, .PPFICATION FO►_the �e <br />ITT OF »R CITY CONSTRUCTION <br />COF <br />everett PERMIT <br />BUILDING DEPARTMENT 259-8745 TO BE COMPLETED IN INK PLEASE PRINT <br />Ll DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />❑ SIGN <br />Cltt ZIP PHONE <br />/ MAIL ADDRESS C// Ve v'e 77" 9$� 3 7C <br />OWNER / U <br />X NL(C eJ l (J E cm ZIP PNONE <br />CITY ZIP PHONE LICENSE A <br />MAIL ADDRESS <br />GENERAL CONTRACTOR <br />X S'4�, y — <br />Cltt ZIP PHONE LICENSE <br />MAIL ADDRESS <br />MECHANICALOONTRALTOR <br />CITY 21P PHONE LICENSE a <br />MAIL ADDRESS <br />PLUMBING CONTRACTOR <br />CLASS OF WORK <br />❑ REPAIR <br />❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT BUILDING RELOCATION <br />❑ NEW A ADDITION ❑ ALTERATION <br />VALUATA N.QF WORK (COSTf/OFF MATERIELS PLUS LABOR) <br />O"` <br />X fy/� a <br />DESCRIBE WORK <br />THAT I HAVE READ AND EXAMINED THIS AP- <br />USE OF BUI..LyyDING <br />I HEREBY CERTIFY <br />KNOWTHESAMETO BE TRUE ANDCORRECT. ALL <br />KPLICATIONAND <br />PROVISIONS OF LAWS AND ORDINANCES GOVERN!NG THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTAC H FOURCOPIESI <br />F WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE* <br />SUME TO <br />OF A PERMIT DOES NOT PREOr <br />y <br />/\LOT LBLOC IL�OF <br />IN OR NOT. THE GRANTING <br />E OR CANCEL THE PROVISIANYOTH <br />LOCAL LAW REGULATING CONSTROUCTION <br />ROSTIATEOR <br />' OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE O NTRACTOR OR AUTHORIZED AGEN/T DATE <br />CITY BUSINESS LICENSE NO <br />DJECT ADDRESS <br />&3og5 /YJA6Lwolq eve f ws 9s�a3 <br />8 <br />M <br />IV UI. rcc <br />BY BUILDING <br />DEPT. PERSONNEL <br />THIS PORTION TO BE COMPLETED <br />'RONT SETBACK REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK i <br />PLANCHECKN MEER � RECEIPT <br />1p I Q� FEE <br />9-7 <br />/ 1Fo v <br />USE ZONE LOT AREA C <br />OYES S)0 <br />OYES/�\j0 <br />FEES <br />VALUATION <br />TYPE OF CON S_TT OCCUPANCY GROUP <br />NO. OF DUNITS <br />SWWELLING r}� <br />Y� <br />R 5 <br />BUILDING <br />yJ <br />SIZE O <br />L/>i� NO.OF STORIES <br />MAX . OCC. LOAD <br />PLUMBING <br />p <br />/ <br />/Y <br />- <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES NO <br />OTHER <br />PENALTY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />APPLICATION ACC. BY <br />TOTAL <br />/w?& <br />G. - G <br />,,-X <br />FEE <br />