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�� <br />everett <br />BUILDING DEFARTMENT <br />259•8745 <br />..PPLICATION FO._ <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETEO IN INK - PLEASE PRINT <br />O DEMOLITION �COMBINATION ❑ BUILDING <br />DWNER M�IL AD�PE55 <br />�,�cH��c +���� asoe �ND <br />�TEC70NOESiGNEN MMLADDRE55 <br />�Ik�K co�R'vrnay Itic. 3�cti-A i iz�s <br />l R�LCONIReC70P MqL�DO1E55 <br />❑ MECHANICAL <br />Evoe��r <br />cm <br />-' •^"^c LICENSE • <br />MECn�NiC�I LONTR�CIOfl MML 11DORE55 CiIY 2�P PHONE LICENSE • <br />� <br />e <br />❑ PLUMBING ❑ SIGN <br />PHONE <br />�..sz-sa3� <br />PNONE <br />�c�_i�u�., <br />rIUMlIHGCOHiR�CTON M�IL �DDRESS CiTY 21P PNOHE IICENSE • <br />C1�S50F WONK p� <br />❑ NEW ��>�q ALTER�TION � HEPAIR ❑ DEMOLITION ❑ WOODSTOYE/FRPL.INSEFT ❑ BUILDING RELOCATION <br />Oi BWIC�NG <br />I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THI� Ap• <br />PLICATIONAND KMOW THE SAME TO BETRUEANDCORRECT. ALL <br />PROPERTY�SHOWNBEIOWUR�Ti�GMFOURCOPiES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />�or l%—d� ��Tr A�AT OFWORKWILLBECOMPLETEDWITHWHETHEHSPECIFIEDMERE• <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 OR LOCAL LAW REGULATING CONSTRUCTION <br />OR 1HE PERFORMANCE OF CONSTRUCTION. <br />SIGNRTURE OF CONiq�CTOfl OP AUTNOqILED �GENi D�TE <br />OF <br />WI,TER HEATER <br />_ TOTAL FEE � � I I I T0Tl1l FEE { L <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />•RONTSEIi��LN' REeRSETB�CM ' <br />� <br />USEZOflE IOi�RE� <br />R-5 �3000�,.._ <br />��_� <br />TVPEOfCONST s(Da OCCl1P�NCYGRD <br />� N "'�INR wau R-1 <br />SRE Of BIDG YO Oi SiORIES <br />loogx3 r3o24� 3 <br />�PPI IG1iON �CC BY <br />M,�t� <br />� <br />WC�NT 17E <br />❑TES �NO <br />NO.Of OWELLINd UNITS <br />3 <br />I� <br />L�N GNECN NUMBER <br />� � �l iv� <br />FEEB <br />aui�oiNc <br />PLU6IBING <br />MECMANIC�L <br />OTHl9 L <br />FEE 3�a s5 I RfCEiPT NO a� D(� p <br />O O >/ <br />��lU11T10N FCk , <br />s <br />PENFLTY � � <br />APPR fOP ISSU�NLE BY <br />TUT�L I � <br />G.-c, — - <br />�e� f�..r�4 � Mr.z�� � <br />�� ��.Mct.ir�r l��'8'(� <br />���� <br />� <br />