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fM En�pn�n <br />Gltt OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />��'PPLICATION FO��� <br />C=DNSTRUCTION <br />PERAAIT <br />TO BE COMPLETED IN INK • PLEASE PRIPiT <br />evereN <br />e <br />❑ DEMOLITION ❑ COMBINATlON ❑ BUILDING O MECHAtJICAL ❑ PLUMBING ❑ SIGN <br />MML�O�RESS CiTY ZiP OHONE <br />OWNER EF•erett 98201 252-6465 <br />Kenneth DeBoer 3224 Hoyt . � tt Z„ P11pNE , <br />ARGNrtECTOA�E910NEN MeRApOPE59 <br />6ENERGLCONTP�CTOR <br />MAII a00FE55 CItY ZIP PNONE IICENSE • <br />�t+erett Bldrs. Inc. 5606 �erRreeri Way Ll�erett 98203 353-7161 EVIItEB�`30 P <br />�iry t�p PNONE UCENSE • <br />_.. __..__.,....� M�ILP�DRE55 <br />P1.UMBING GONIRACiON <br />MAILApORE55 CITV ZIP P��ONE LICENSE• <br />❑ NE�N ❑ AODI710N ❑ ALTERATION <br />...........�.,c wnve�ensl nF MATERIRLS PLUS LABOBI <br />REPAIR ❑ DEMGLI710N ❑ WaODSTOVE/�RPL.INSERT ❑ BUILDING F.ELOCATION <br />4 154.00 — <br />oescRioe wonK <br />Foundation Repair <br />OR nTTACN FOUR COPIESr <br />LOT-BLOGI�--�r - <br />�erett Plat of &IX 769 0-000 Lots 21 and 22 <br />eooaess <br />I HEREDY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BETRUEANDCORREC'f. ALL <br />PROVISIONS OF LAWS ANO OFDINANCESGOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SP'cC!FIED 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 C�R LOCAL LAW REGULATING CONSTRUGTION <br />OR THE PGRFGRM�4NCE OF CONBTRUCTION. <br />SIGNAiURE Of CONTPRCTON OR nUTHOP�2ED AGENT DATE <br />X ���C}�ti !"�t �i'ta-� � -a7r gg <br />�o <br />-ruic pnRT�nN m BE COMPLETED BY BUILDING DEPT. PERSUNNt� <br />� <br />