Laserfiche WebLink
�� <br />.� <br />tM Enrpn�n <br />an oF <br />everett <br />BUIIDING DEPARTMENT <br />259•8745 <br />� '. : 1 <br />�i�PPLICATION FOk'' <br />CONSTRl1��..T�ON ' <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRIN'� <br />���rcM <br />e <br />G DEMOIITION ❑ COMBINATION 1jjBUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER M�ILAODPE55 GITY 21P PHONE <br />��n��TRAMM �3��o WAL�- ST �VE�ETf oZSB-lq Iq <br />MCHIfECTONDESIGNER M�ILADDf1E53 CITY ZIP PHONE <br />O�{i�EK-� II �. Ii <br />OENEMICONTRAQOR M�IL�DDHE53 Cltt 21P PMONE LIGENSE• <br />CITY LIP PMON[ LIGfiNSE • <br />KUMSINOCUMlM��TOR 4ML�DORE39 CIIY 21P PIIONE LICENSE• <br />1�011� <br />u�ssorwonK _.. .. '1 <br />❑ NEW I� ADDITION ��ALTERATICN ❑ REPAIR C� OEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINO RELOCATION <br />�,� o[xnme w <br />�, �i�51 <br />� LE011� DE9( <br />i: <br />- �or__ <br />�i <br />�._ <br />�, �,�12�L2sr ��c�t�. <br />� <br />ij <br />� <br />IION7 6ETB/�LK <br />!E LONE <br />c-a <br />YPE OF CON9T. <br />g =N <br />ALE Df BLUQ /Q <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAMETOBETRUEANDCORRECT. ALL <br />ON�TT�CHFOUqGOPIEb� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHEiHER SPECIFIED HERE• <br />IN OR NOT. THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO <br />CaIVE AUTHORITY TO VIOLATE OR CANCEL THE PROb'ISIONS OF <br />�( /K� ANYOTHER STATE OR LOCAL LA1N REOULATINO CONSTRUCTION <br />OR THE PERFORMANCE OF CO�STRUCTION. <br />SIONIINRE OF CONTR�CTOR OR AUTHORI2'D �OENT D�TE <br />X%1 / � . � r-i.. /... � <br />•PPLIC�Ni9 CITY <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />iU n- <br />10T1 <br />N,t �vA <br />WC�NT 9�TE <br />OYE9 �NO <br />UP HO.OFOWELLIN <br />�� Z �� <br />MI1X OC4 LO�D <br />/3 <br />CHECItEU BY �PPR. FON ISSUA� <br />� L �G <br />�7(18183 <br />Flft <br />BUILOINO <br />PLUMBINO <br />MECHANICAL <br />O1MER <br />PENAITY <br />TOTAL <br />_ <br />VI1W11TION I F[[ <br />