Laserfiche WebLink
1n�ErerprNn . �PPLICATION FO►_ <br />°�ry°° CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />eocretl <br />� ; <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL C13�tLMBING ❑ SIGN <br />owr¢n Mni�noeaess cm nr vr�or�e <br />%�SreS�mrr,� 33at ��bVf <br />�NCMIIECIOROESIGNER M11LApORE55 CILY IIP GIIONC <br />CENER�LCONiRAOtOR M�ILApOFE55 Clry ZIP PIIONC LIC.ENSE• <br />IIIOIANiULCpNIR.lCipq M�ILADOR[55 CIiY ZiP PnOt�E �ILCNSF • <br />PI{n1NI9v1.0 NiP Q\OR IA�iIApORE. CIiV ZIP �I�pqE liCliRC • <br />I V `/ �lu�,k �� �3 ��I u� �.t2es rDiz t3a��de ll �l,fo �z 33 �- i�» ;.i�I7KN .. <br />CLASSO� WOPN ���'� <br />❑ NEW ❑ ADDI710N ❑ ALTERATION ❑ FEPAIR ❑ DEMOLIilO1J ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING PELOCnTl0�1 <br />VA� W �ION Of WORN �LOSi O� A�FtCRIRLS PW$ LPBOPI <br />IISE <br />irvE <br />0 <br />WATE{i <br />FLOOR DFAIN <br />TYPE OF <br />RMIT <br />� n: S/ C'� {.h C'P_ I HBREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLIGATIONANDKNQWTHESAMETOBETRUEANDCORRECT.ALL <br />onan�cnvouncaries pROVI510NSOF�AWSANDORDINANCESGOVERNINGTHISTVPE <br />OF WORK WILlBE COMPLETED WITH WHETI�ER SPECIFIED HERE- <br />IN OR NOT. THE �RANTING OF A PERMITDOES NOT PRESIIME TO <br />GIVE AUTHORITY TO VIOLATt OR CANGE. THE PROVISIONS OF <br />AN'f OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION <br />OR THE P FORMANCE OF CONSTRUCTION. <br />SIGNAiURE CONIH tORO�i/+VIIIpqILE�aGENt DA1E <br />X '"� �� � �P� �S <br />APPU PN�SGRYBUSINESSLiC[N9EN0 <br />NO. <br />UIJIT HEAIERS—B1. <br />THIS PORTION TO BE COMPLETED BY BUIL�ING DEPT. PERSONNEL <br />nER15EtORCN SIpE5Ei8ACK PLRNCNECNNUMOEA vLSn CniC�t[t. <br />!EE n[�EiPf �i0 <br />LOf �PEA VALANi SitE <br />❑YES pN0 FEES V�LIIITION PEE <br />OCCUPANGYGROIIP NOAGOWELLINOUNITS , <br />Bv <br />NO Of <br />❑ur�s cnecKeo <br />ar <br />�UILOING <br />PLUMBING <br />MECHANICFL <br />OTHER <br />PENPL7Y <br />TOTAL <br />S <br />3 <br />